Procedure for the Management of a Patient being Absent without Leave (Absconding) from a Hospital Environment

Procedure for the Management of a Patient being Absent without Leave (Absconding) from a Hospital Environment

Name of Procedure: Purpose of Procedure: Directorate responsible for Procedure Name & Title of Author: Trade Union consultation? Equality Screened by: Procedure Checklist Management of a Patient being Absent Without Leave (Absconding) from a Hospital Environment To outline the action to be taken by staff in the event of a patient going missing from a general hospital environment without prior agreement, or failing to return at the agreed time. Acute Anita Carroll, Assistant Director of Acute Services - FSS Yes/No/Not Applicable Anita Carroll, Assistant Director of Acute Services - FSS Date Procedure 10 th December 2012 submitted to Policy Scrutiny Committee: Members of Policy Scrutiny Committee in Attendance: Vivienne Toal, Head of Employee Engagement & Relations (Chair), Anne Brennan, Senior Manager, Medical Directorate, Anita Carroll, Assistant Director of Acute Services Functional Support Services, Claire Graham, Head of Corporate Records (for Siobhan Hanna), John Graham, Trade Union Side representative, Carmel Harney, Assistant Director of Allied Health Professionals, Governance & Workforce Planning, Marita Magennis, Head of Social Work and Social Care Governance, Stephen McNally, Director of Finance & Procurement, Fiona Wright, Assistant Director of Nursing Services, Governance & Workforce Planning Procedure Approved/Rejected/ Amended Procedure Implementation Plan included? Any other comments: Date presented to SMT Director Responsible Approved. Yes Advised to change policy to a procedure. Director of Acute Services SMT Approved/Rejected/Amended SMT Comments Date for review 2 year default

PROCEDURE DOCUMENT VERSION CONTROL SHEET Title Management of a Patient being Absent Without Leave (Absconding) from General Hospital Environment Version: 1.0 Reference number/document name: Supersedes Supersedes: Description of Amendments(s)/Previous Policy, Procedure or Version: Originator Name of Author: Anita Carroll Title: Assistant Director of Acute Services - FSS Scrutiny Committee & Referred for approval by: SMT approval Date of Referral: 10 th December 2012 Scrutiny Policy Committee Approval (Date) 10 th December 2012 SMT approval (Date) Circulation Issue Date: Circulated By: Issued To: As per circulation List (details below) Review Review Date: December 2014 Responsibility of (Name): Anita Carroll Title: Assistant Director of Acute Services - FSS

Contents Page No. 1.0 Introduction 5 2.0 Purpose 5 3.0 Rationale for the Procedure 5 4.0 Scope of Procedure 6 5.0 Responsibilities 6 6.0 Legislative Compliance, Relevant Policies, Procedures & Guidance 7 7.0 Equality and Human Rights Considerations 7 8.0 Alternative Formats 7 9.0 Copyright 7 10.0 Sources of Advice and Further Information 8 Procedures 9 Appendices Appendix 1 Absent Without Leave Procedure Checklist 12 Page 4 of 14

1. INTRODUCTION Absconding or absent without leave refers to departure of a patient from a ward/ department without prior arrangement. The circumstances by which a patient may be missing from hospital without first discussing his or her absence with staff may be varied. A voluntary patient may lawfully leave hospital anytime he or she wishes, however it would be desirable he/she discusses this with staff in the first instance. Action must be taken however if the patient lacks mental capacity or there are concerns that the patient represented a significant risk of harm to him/herself or others. 2. PURPOSE The purpose of this procedure is to outline the action to be taken by staff in the event of a patient going missing from a general hospital environment without prior agreement, or failing to return at the agreed time. 3. RATIONALE FOR THE PROCEDURE 3.1 As part of the orientation process when a patient is admitted, Nursing/Midwifery staff must make patients aware that whilst they are at liberty to leave and return to the ward/ department at any time, it must be planned and agreed with the Nurse/Midwife in Charge of the ward/ department. 3.2 Staff caring for the patient must assess whether the patient is well enough to leave the ward/ department, and whether they should be accompanied if they do leave. Staff should ascertain why the patient wants to leave, and where they are going plus the estimated length of time they will be away from the ward/ department. Staff must be sure it is safe for the patient to leave. 3.3 Certain patients may represent an increased likelihood of absconding from hospital care for a variety of reasons such as: patients with previous history of absconding those with confusion/disorientation patients under the influence of drugs and/or alcohol those with cognitive impairment who are not capable of maintaining their own safety those with psychological disturbance those with a mental illness (This list is not exhaustive of the circumstances/conditions where there would be an increased likelihood of a patient being absent without leave.) 3.4 Where there is an increased likelihood of a patient being absent without leave, the multi-disciplinary team must consider forward planning to address this likelihood and have measures in place including a recorded risk assessment in the patient s record that will enable staff to respond Page 5 of 14

quickly and appropriately to such eventualities. This should be reflected in the patient s record and communicated to all staff involved in the care of the patient. 4.0 SCOPE OF THIS PROCEDURE This procedure applies to Acute and Non-Acute hospital settings within the Trust namely:- Craigavon Area Hospital Daisy Hill Hospital Lurgan Hospital South Tyrone Hospital Mullinure Hospital This procedure excludes Bluestone Unit and St Luke s Hospital as these are covered by other procedures. 5.0 RESPONSIBILITIES 5.1 Chief Executive 5.1.1 The Chief Executive has overall responsibility if a patient goes absent without leave. 5.2 Directors 5.2.1 The Chief Executive requires Directors to establish and monitor the implementation of these arrangements and compliance within their area of responsibility. 5.3 Managers All Assistant Directors, Heads of Service, Lead Nurses/Midwives and Ward/Department Managers/ Site Managers have responsibility for ensuring that:- 5.2.1 All staff are aware of this procedure and that they are implemented within their area of responsibility. 5.2.2 Assessments of patients on admission are undertaken to identify any risk of absconding. 5.2.3 Measures are put in place where there are patients with a known risk of absconding. 5.2.4 General measures are taken to reduce incidences of patients absconding for example: Effective admission arrangements. Patients involved in care planning and delivery. Page 6 of 14

Pro-active engagement with patient and their family/carers. Ward/Department environment must promote patient safety. 5.2.5 All absconding incidents are reported in accordance with the Trust procedure for reporting accidents/incidents. 5.4 Trust Staff 5.3.1 To familiarise themselves with this procedure and adhere to the contents. 5.3.2 Advise line managers of any concerns or risks. 5.3.3 Ensure that their actions are prompt, thorough and sensitive. 6.0 LEGISLATIVE COMPLIANCE, RELEVANT POLICIES, PROCEDURES AND GUIDANCE SHSCT Management of Violence and Aggression Policy and Procedure SHSCT Management of Adverse Incidents Policy SHSCT Security Management Policy 7.0 EQUALITY AND HUMAN RIGHTS CONSIDERATIONS This procedure has been screened for equality implications as required by Section 75 and Schedule 9 of the Northern Ireland Act 1998. Equality Commission guidance states that the purpose of screening is to identify those procedures which are likely to have a significant impact on equality of opportunity so that greatest resources can be devoted to these. Using the Equality Commission's screening criteria, no significant equality implications have been identified. The procedure will therefore not be subject to an equality impact assessment. Similarly, this procedure has been considered under the terms of the Human Rights Act 1998, and was deemed compatible with the European Convention Rights contained in the Act. 8.0 ALTERNATIVE FORMATS This document can be made available on request in alternative formats, e.g. plain English, Braille, disc, audiocassette and in other languages to meet the needs of those who are not fluent in English. 9.0 COPYRIGHT The supply of information under the Freedom of Information does not give the recipient or organisation that receives it the automatic right to re-use it in any way that would infringe copyright. This includes, for example, making multiple copies, publishing and issuing copies to the public. Permission to re-use the information must be obtained in advance from the Trust. Page 7 of 14

10.0 SOURCES OF ADVICE AND FURTHER INFORMATION Line Managers should be contacted in the first instance, in relation to any specific queries on the content of the Procedure. Line Managers should then escalate queries which they are unable to address, to the Procedure Author. Page 8 of 14

1.0 DEFINITIONS ABSCONDING PATIENTS PROCEDURES 1.1 A patient must be considered as absent without leave when he/she: Fails to return from leave at an agreed time without giving details of his/her whereabouts to the ward/ department; Leaves a ward/ department without the knowledge of staff; Evades his/her escort (whilst being accompanied by staff) and cannot be found. 1.2 Nurse/Midwife in Charge refers to the person in charge of the ward/ department at the time. 1.3 In Integrated Maternity and Women s Health Division the procedure should be referred to if mother / mother and baby are absent. 2.0 STEPS TO BE TAKEN WHEN A PATIENT IS NOTICED TO BE ABSENT WITHOUT PRIOR AGREEMENT 2.1 If a patient, has been noticed absent without agreement, or failed to return to the ward/ department at the agreed time, then the Nurse/Midwife in Charge of the ward/ department should try to locate the patient by initially searching the immediate area, then via a mobile telephone, home telephone, and regular point of contact. At this stage the Lead Nurse/Midwife/Head of Service or Site Manager (if out of hours) must be informed. 2.2 The Nurse/Midwife in Charge of the ward/ department must organise a search of the wards/ departments/ hospital grounds with the assistance from Security/Porters (where available). Portering staff should also be alerted to be vigilant in the vicinity of the hospital and grounds. Searches beyond the immediate vicinity must be carried out by the police (PSNI). Staff are not permitted off site. 2.3 If the patient is not located and the Nurse/Midwife in Charge has concern he/she will check the patient s record and contact relevant personnel which may include the following. NB This list is not prescriptive. 1. Ward Sister/Sister in Charge and the Lead Nurse/Midwife 2. Site Manager 3. Consultant in Charge of patient or most senior doctor available 4. The patient s next of kin/carer, PSNI, Child Protection Nurse, General Practitioner, Community Psychiatric Nurse, Social Services or any other person they feel may be able to assist in trying to identify the whereabouts of the patient. Page 9 of 14

The Nurse/Midwife in Charge will have responsibility for ensuring the completion of the Absent Without Leave Procedure Checklist (Appendix 1) which could be used to assist locating the patient. 2.4 The Nurse/Midwife in Charge, upon notification has a responsibility in turn to inform the Consultant in Charge of the patient, or in his/her absence, the on call Consultant and complete an assessment of risk. 2.5 The Nurse/Midwife in Charge will provide the next of kin/carer(s) with advice about what to do if they locate the patient and a specific point of contact for communicating with staff throughout the period of absence. 2.6 In situations where there is a significant risk associated with the patient (irrespective of their legal status) remaining outside the hospital environment or another person is at risk in the community, for example the patient s child or wife/husband, this must be communicated to the PSNI by the Nurse in Charge following detailed discussion with the Consultant and the Ward Sister/Sister in Charge or Site Manager (Out of Hours). Whilst the patient s right to confidentiality must be considered, the safety of others is considered to supersede the patient s right to confidentiality where significant risk exists. This discussion should be documented fully in the patient s record. Information provided to the PSNI should include a full description of the patient, possible whereabouts and the risks posed to the patient or others. 2.7 If the patient absent without leave is detained under the Mental Health (NI) Order 1986 then the Head of Service will inform the relevant Assistant Director, who will advise on informing the Director, the Regulation and Quality Improvement Authority and the Head of Communications. The PSNI must be informed of a detained patient who is absent without leave as the PSNI under Article 29 of the Order have a responsibility to assist in returning the patient to a place of safety. 2.8 Patients who are concerned in Criminal Proceedings or Under Sentence, Part 3 restricted Patient MH (NI) Order and are absent without leave the Department of Justice must be informed. 2.9 Full, contemporaneous records of all action taken must be made in the patient s record and other relevant documentation. 3.0 ONGOING REVIEW AND ACTION PLAN WHEN A PATIENT IS LOCATED 3.1 If the patient is located, is safe and returns to the ward/department then the Nurse in Charge must assess the patient and make a note in the patient s record to this effect. 3.2 The Nurse in Charge should contact all relevant personnel to notify them that the patient has returned. 3.3 If concern exists that the patient may subsequently abscond again Page 10 of 14

following their return then options to prevent this, should be considered by the multi-disciplinary team and appropriate action taken. 3.4 An Incident Form must be completed in accordance with the Trust procedure for reporting of accidents/incidents. 4.0 WHEN A PATIENT REFUSES TO RETURN OR CANNOT BE LOCATED 4.1 If the patient is located and refuses to return, attempts should be made to persuade the patient to return. The Nurse in Charge will discuss the case with the responsible Consultant in Charge or most senior doctor available and if there are concerns regarding the patient s mental capacity for making an informed decision then urgent referral should be made to the appropriate Mental Health Team. 4.2 If the patient is located and refuses to return, and there are no concerns regarding their mental capacity, following consultation and agreement between Consultant and Ward/ Department Manager the patient should be discharged from hospital in accordance with Hospital Discharge Procedures. 4.3 If it has not been possible to locate the patient within 24 hours consideration should be given to discharging the patient in their absence. Ongoing enquiries with regard to the missing patient will continue by the PSNI. The PSNI will maintain an active case file and will take the lead role in co-ordinating and leading the ongoing enquiries. 4.4 An Incident Form must be completed in accordance with the Trust procedure for reporting of accidents/incidents. 5.0 PRESS ENQUIRIES / PRESS RELEASES 5.1 All press enquiries received should be directed through the existing channels in respect of press enquires. At this point, the Head of Service should undertake to ensure that the Communications Manager has been briefed on the developing circumstances. 5.2 If the Clinical team feel that a press release with regard to concerns relating to a missing person may be beneficial, then this should be discussed with the Communications Manager who will explore with the Police. Page 11 of 14

Appendix 1 Absent Without Leave Procedure Checklist CHECKLIST TO BE COMPLETED BY NURSE/MIDWIFE IN CHARGE IN THE EVENT OF A PATIENT ABSENT WITHOUT LEAVE Patient Name: Address: Hospital Number: Date of Birth: Telephone/contact details: Ward/Dept: Date of Admission: Patient noticed missing. Date: Time: Circumstances: Risks/concerns: Action Taken on discovery of a patient absent without leave (please tick as appropriate): Action Yes No Name of Contact Date & Time Page 12 of 14

Ward/Dept searched? Security Porters/ Porters contacted? Grounds searched immediately? Hospital Buildings searched? Ward Sister/Sister in Charge Lead Nurse Site Manager Consultant or most senior doctor available Child Protection Nurse Next of kin/carer Casualty Departments PSNI IR1 completed? Key worker contacted? GP contacted? Social Worker contacted? Communications Department Department of Justice Action Taken as required on return (please tick as appropriate): Action Yes No Name of Contact Date & Time Ward Sister/Sister in Charge Lead Nurse Site Manager Consultant or most senior doctor available Child Protection Nurse Next of kin/carer Casualty Departments Page 13 of 14

PSNI Key worker contacted? GP contacted? Social Worker contacted? Communications Department Department of Justice Incident recorded in patient s record? Incident Form completed? Signature of Nurse in Charge: Date: Comments re action taken on return, eg likelihood of subsequent absconding. Plan of action from multidisciplinary team, eg discharge, interventions to reduce the potential of further incidents of absconding (give date of discharge if applicable). Signature of Ward/Dept Manager: Signature of Team Leader: Signature of Head of Service: Date: Date: Date: Page 14 of 14