A multifaceted intervention has reduced elopements at a psychiatric hospital in Florida.
"Elopement is a problem when you are taking in patients at risk of harm to self or others. We're responsible for them. Now we've got a better handle on it," Daryl Anne Cummings, MSN, RN-BC, from University of Florida (UF) Health Shands Psychiatric Hospital, in Gainesville, told Medscape Medical News.
Cummings presented her research in a poster session at the American Psychiatric Nurses Association (APNA) 29th Annual Conference. The poster won first place in the "Administration" award category.
Shands Psychiatric Hospital is an 81-bed acute care academic medical center that serves as a training facility for multiple colleges and universities and disciplines. A major challenge is high traffic volume. "The main entrance doors are opened approximately 7000 times, and each unit door is opened 4000 to 5000 times per week," Cummings said.
A multidisciplinary team involving facilities/maintenance, nursing risk managers, security, and administration came together to vet the problem of elopement and develop a multifaceted elopement reduction action plan (ERAP). Key elements include use of technology to secure the perimeter, open-door alarms that sound after 15 seconds, and extensive staff education and monitoring for compliance.
Another major component was implementation of a unique individual code system for staff. "We had a single-swipe system using badges, but we had a badge stolen, with a very bad outcome. We also had a couple other near-miss elopements, which could have caused harm to the patients," Cummings explained.
Now, each individual staff member has his or her own unique four-digit code system to use when coming and going, she said, although medical students rotating in and out remain a problem. "We've started doing resident education every June before they arrive in July, which has helped, but we still have to monitor that quite a bit," Cummings said. "We also have some signage on every locked door that helps people get over the need to hold the door for someone else."
The facility also updated their doors. "We had a problem with some patients who were able to kick the metal doors and pop the magnetic lock. We now have wood composite doors, and we don't believe those can be popped open," Cummings explained.
Since the ERAP was implemented, "no one has gotten from a nursing unit to outside of the building. It's working extremely well," she said.
Hiding in Plain Site?
David Meek, RN, MA, BSN, founder of the National Institute for Elopement Prevention and Resolution (NIEPR), in Topeka, Kansas, told Medscape Medical News that it is important to realize that patients can elope yet never leave the building.
"They can be hiding in the building. In long-term care, the largest award I am aware of civil-wise was over $18 million, and the woman was only missing for 4 hours. The problem was, she was in the walk-in freezer and, of course, succumbed to injuries from the hypothermia. There was also a case of a woman missing for 5 days, and she was found between a desk and a wall in a room where furniture was stored. She had climbed up on a desk to try to go out a window and had fallen," Meek noted in an interview.
The NIEPR (www.elopement.org) defines elopement as follows: Elopement occurs when a patient or resident who is cognitively, physically, mentally, emotionally, and/or chemically impaired wanders away, walks away, runs away, escapes, or otherwise leaves a caregiving facility or environment unsupervised, unnoticed, and/or prior to their scheduled discharge.
"You can't prevent all elopements in a therapeutic environment. Elopement is probably a bigger problem than most people understand because we only tend to hear about the ones with really negative outcomes," Meek said.
He said the use of technology and ongoing education and training of staff, which the Shands ERAP includes, are "important." He questions the 15-second door-open alarm, noting that "a lot can happen in 15 seconds."
Meek also encourages individual patient risk assessment. "An active exit-seeker needs more intervention and attention. They are the most difficult and the ones who tend to get out or elope, because they are actively looking to get out," Meek said. Clearly, all facilities also need a response plan when faced with an elopement, he noted.
The study had no commercial funding. The authors and Paul Meek report no relevant financial relationships.
American Psychiatric Nurses Association (APNA) 29th Annual Conference. Poster 3. Presented October 29, 2015.
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Cite this: Novel Approach Curbs Psychiatric Inpatient Elopement - Medscape - Nov 05, 2015.