![]() ![]() The Joint Commission's sentinel events policy defines "any elopement, that is unauthorized departure, of a patient from an around-the-clock care setting, resulting in a temporally related death (suicide, accidental death, or homicide) or major permanent loss of function" as a reportable sentinel event.( 5) This reporting requirement reflects the level of harm to the patient regardless of the patient's intent to leave or mental capacity. Patients who are able to make determinations about their own care should be given guidelines upon admission that outline their rights and responsibilities while hospitalized, including the need to communicate with staff prior to leaving a treatment area. ![]() In most organizations, this conversation is recorded in the medical record and the patient is asked to sign a form indicating that they are aware of the risks and that they are leaving against medical advice. In such cases, the physician should inform the patient of the risks associated with leaving. Leaving against medical advice (AMA) is different from elopement or wandering and is determined by the patient's decision to leave the facility having been informed of and appreciating the risks of leaving without completing treatment.( 4) Fully competent patients are legally able to discharge themselves without completing treatment. ![]() According to the VA National Center for Patient Safety (NCPS), elopement is defined as: "A patient that is aware that he/she is not permitted to leave, but does so with intent."( 1) In many cases of elopement, the patient may have a decreased mental capacity related to dementia or temporary delirium, or intermittent mental status changes related to medication, disease, or traumatic injury.( 2) Despite the level of capacity or intent, both of which may be difficult to determine, eloping patients are often at risk for serious harm, and there are many cases where patient elopement has resulted in death.( 3) On the other hand, wandering refers to a patient who "strays beyond the view or control of staff without the intent of leaving (cognitive impairment)."( 1) Wandering can also lead to significant safety risks when the patient has decreased capacity.( 2) (For more information on elopement terminology, see Table.) Such behavior was typical for this patient, who was known for being one of the hospital's "frequent flyers." However, when he did not return 3 hours later, security was called to locate him.įinding that a patient has "gone missing" is a scary situation for providers and patients' families. On the morning of anticipated discharge, he was not in his room at the time of the physician's visit. ![]() After being treated for his worsening cardiomyopathy and renal failure, his mental status began to clear. Identify legal risks associated with elopement.Ī 61-year-old male with a history of chronic pancreatitis and cardiomyopathy attributed to alcohol was admitted for chest pain, acute on chronic renal failure, and altered mental status.Describe strategies for preventing elopement and steps for responding after a patient elopement has been identified.Identify leading contributors to elopement events.Define elopement and differentiate it from wandering and leaving against medical advice. ![]()
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