CODE YELLOW (MISSING RESIDENT)

CODE YELLOW (MISSING RESIDENT)

CODE YELLOW In all health care facilities - but particularly in those that provide long-term care there is a risk that residents will elope or escape. Our residents are assessed for their potential to elope (or wander) on admission to St. Joseph s Health Centre ( the Centre ) and on a regular basis thereafter. Based on these assessments, appropriate interventions are put in place. The facility also uses special exit locks and alarm systems in an effort to keep residents safe. In spite of these measures, residents may elope because they: are confused and/or wander as a result of dementias or other cognitive impairments (see Appendix 1); have impaired judgment related to acquired brain injuries; may be depressed or self-destructive in response to chronic complex medical conditions, etc. Unfortunately, residents who leave our Centre (intentionally or as a result of impaired judgment or a tendency to wander) may be at risk for injuring themselves or others. CODE YELLOW is the procedure that is used to organize a systematic effort to locate missing residents and prevent or minimize harm to themselves and others. Please Note: It is assumed that, prior to initiating a CODE YELLOW procedure, reasonable efforts have been made to ensure that the resident is actually missing rather than simply at another location within the building (i.e. coffee shop, hair salon, pub, etc.). Code Yellow - Revised Dec/02 2 of 7

CODE YELLOW PROCEDURE The Senior Staff Member in the CODE YELLOW location will act as Leader during the procedure outlined below: 1. Staff in the missing resident s neighbourhood/program conduct a systematic search of the IMMEDIATE neighbourhood or program area ONLY and establish when the person was last seen. 2. As soon as it is determined that the resident is MISSING, the staff that are most familiar with the resident will assess the level of risk. For example: Is this a resident who is physically healthy, able to cope with superficial social interaction, but known to wander? Would people who were unfamiliar with the resident overestimate his or her cognitive abilities? Is this a resident who frequently threatens to leave or do himself harm? 3. If the resident is considered to be at high risk (to himself or others), staff will notify the police immediately by calling 9-911 before proceeding with the remaining steps in the CODE YELLOW procedure. 4. In preparation for a more widespread search, staff familiar with the resident will prepare a description of the missing person for other staff and/or police to use when searching. The description of the resident should include the following information: name; age; height & weight; hair & skin colour; distinguishing features; clothing type, colour, footwear; general condition; any information that might assist staff in approaching the resident or obtaining the resident s cooperation in returning to the facility; and, the time and place the resident was last seen. If possible, provide a current photograph of the resident. Code Yellow - Revised Dec/02 3 of 7

5. Call for additional assistance in conducting a systematic search of the entire facility as follows: If the incident has occurred on or near a resident neighbourhood, the individual should proceed to the red Emergency Telephone (found in a recessed box on the wall beside each Medication Room as you exit from any pair of neighbourhoods), pick up the receiver to activate the emergency overhead paging system and CLEARLY announce CODE YELLOW [LOCATION] (neighbourhood and/or room number) THREE TIMES. If the situation has occurred anywhere else within the facility, direct the individual to call 0 and ask the Switchboard Operator to use their own Emergency Telephone to announce CODE YELLOW [LOCATION] (department, program area and/or room number) THREE TIMES. When the Switchboard area is not staffed, calls will be forwarded to the Security Guard on duty and security personnel will access the closest Emergency Telephone to announce CODE YELLOW [LOCATION] (including room number). Please Note: ALL AVAILABLE STAFF - including the Security Guard (when on duty) and any available administrative staff - should REPORT to the announced location to assist. 6. The Leader will obtain a series of maps that correspond to all of the areas (levels and zones) that must be included in a systematic search of the facility (inside and outside) from the Facility Maps section of this Emergency Manual. As staff arrive at the CODE YELLOW location, they will be given: a description of the missing resident; and, a map corresponding to her/his assigned search area. 7. Each staff member (or pair of staff members) will initiate a systematic search of the assigned area, making sure to check areas that are typically locked or used by staff only. 8. As staff complete the search of the assigned area, they will: go back to the CODE YELLOW location to return the assigned map and report the results of their search; and, obtain another map to continue searching in a new area if that is necessary. Code Yellow - Revised Dec/02 4 of 7

Please Note: The Senior Staff Member is responsible for ensuring that ALL levels and zones are searched. 9. If an internal search of the facility fails to locate the missing resident (and the police were not contacted earlier), call the police immediately at 9-911 to request assistance. 10. At the earliest opportunity, staff in the CODE YELLOW location will notify: the Manager of the department (during regular business hours), or the President/CEO (or Administrator On Call ) at all other times; and, the family (Next-of-Kin or Personal Power of Attorney); As appropriate and time permits, staff in the CODE YELLOW location will notify: the attending physician; and, Social Work and/or Religious & Spiritual Care personnel. 8. When the resident is found, staff will: use the Emergency Telephone (and/or dial Switchboard/Security) to announce CODE YELLOW ALL CLEAR three times. notify the Next-of-Kin or Personal Power of Attorney; and, (outside regular business hours) notify the Administrator On Call. 9. At the conclusion of the CODE YELLOW, staff will document the procedure. The resident s record will include (but is not limited to) the following information: when the person was noted to be missing; who was notified of the Code Yellow; where and when the resident was found; any injuries noted and/or treatment received by the resident; and, any additional follow-up action taken. 10. In any case where the police are notified, an Unusual Occurrence Form must be completed. Code Yellow - Revised Dec/02 5 of 7

If the CODE YELLOW involves a resident in Long-Term Care, a Ministry of Health Unusual Occurrence Report must be completed and forwarded to the Manager of Long-Term Care. If the police are notified in the case of a missing Long-Term Care resident, staff must also notify the Regional Long Term Care Office at 1-866-716-4446. 11. At the earliest opportunity, the relevant Manager will debrief staff and/or review the incident with staff and family to determine: if any existing practices or policies need to be revised; any information and observations that might indicate why the resident eloped (e.g. boredom, a desire to avoid noise or activity, an interest in outside activities or just some fresh air, etc.); what, if any, changes should be made to the resident s plan of care; and, whether or not the resident should be registered with the Wandering Person s Registry (through the City of Guelph Police Department). Code Yellow - Revised Dec/02 6 of 7

APPENDIX 1 DESCRIPTIONS OF WANDERING BEHAVIOUR Purposeful Wanderers Purposeful Wanderers walk around in their room or along the corridors and elsewhere with an apparent intent. They may be exercising, walking to relieve boredom, or just passing the time of day. The Wanderers (and therefore the staff) know where they are. Aimless Wanderers Aimless Wanderers are disoriented and move about without any apparent purpose. They may be looking for some unknown location or somewhere from their past (such as a former home). Aimless Wanderers will also enter other resident s rooms and to explore or rummage through the belongings found there. Aimless Wanderers are confused about where they are. Escapist Wanderers Escapist Wanderers demonstrate a concerted attempt to get somewhere. If restrained, they often become angry or fearful and gentle assurances do not deter them. Escapist Wanderers know where they are (or at least where they are not) and can slip away from a facility undetected. They have some control over their cognitive abilities and may hurry toward their destination. Escapist wandering is a behaviour seen in the middle stages of Alzheimer s Disease. Critical Wanderers Critical Wanderers stray away from the neighbourhood, but do not understand the implications of their wandering behaviour. The wandering becomes critical or the most dangerous when the Wanderer leaves the premises. Critical Wandering has been linked to out-of-facility deaths. Code Yellow - Revised Dec/02 7 of 7