Preventing An Elopement

Risk Assessments

Every facility should develop a method to identify residents who are at risk for elopement, such as known wanderers. A risk assessment should be completed upon resident admit and quarterly thereafter, as indicated. Some diagnoses pertinent to the risk of elopement include:

  • Delusions, Hallucinations.
  • Alzheimer’s Disease, other dementia.
  • Anxiety Disorder, Manic Depression, Schizophrenia.
  • History of wandering.

 

Interventions

Once a resident has been identified as being high-risk, appropriate interventions should be implemented. These should include:

 

  • Behavior Logs – Document wandering tendencies. Once these behav- iors have been exhibited, the potential for elopement increases.
  • Supervision and periodic checks as possible. A secured Alzheimer’s Unit is best.
  • Ongoing activity programs to minimize aimless wandering tendencies.
  • Identification bracelets and/or alarms worn by residents, as indicated. Consider using an electronic ankle/wrist band system with residents who display wandering tendencies, per facility protocol. Both the physician and responsible party should be involved in this process.
  • Exit doors secured with alarms or keypads that are tested daily/weekly according to manufacturer recommendations and documented. The interior stairwell doors should be equipped with alarms reporting to the Nurses Station that will also detect undesired entry to stairwells. All alarm systems should be connected to a central alarm system and should include the ability to monitor elevator access.
  • Fenced yard controls with either an electronic alarm or staff supervision.
  • Install window limiters as approved by state codes.
 

Communication

Once a resident has been identified as being at risk for elopement and preventative interventions have been implemented, everything needs to be documented in the resident’s chart and communicated to everyone involved with the resident’s care, beginning with:

 

  • The resident’s care plan, which should list all interventions that are used to prevent an occurrence from happening. The interdisciplinary team, physician and power of attorney for health care decisions need to be involved with this process.
  • Assignment sheets – All direct-care staff need to know which residents are at risk for elopement and what interventions are needed to prevent an occurrence.
  • Discretely post current pictures of known wanderers to alert staff. Posting should be at the nurse’s station and possibly at the front entry areas.
  • Check-In/Check-Out Logs – Utilize these anytime a resident leaves the facility by self, with family or facility planned outings.
  • The QA committee should review and discuss all elopement concerns whenever indicated. Records should be kept of all incidents so that trends and risks can be identified and reduced.

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