Educating staff to reduce elopements Malissa Williams MSN

Educating staff to reduce elopements Malissa Williams, MSN RN Doctor of Nursing Practice Program

+ Elopement: Background & Rationale

+ Problem Background: Elopement n 18 hour elopement n Issues identified n Critical weaknesses n Institutional problem

+ Background n UPMC patient n n 89 year old female, later found dead National problem n Facilities do not have standard assessment or plan

+ PICOT QUESTION n Will implementing a new education module and having a live-elopement drill improve staff education, decrease elopements, or improve the response to an elopement?

+ Elopement: Literature Review

+ Literature Review n Logsdon, et al. , (1998) n n Bowers, Jarrett, Clark, Kiyimba, and Mc. Farlane (1999) n n Blessed Dementia Rating Scale qualitative data; key feelings were identified as “anxiety, worry and restlessness” Zeisel, et al. , (2003) n privacy, personalization of rooms, common areas being at the end of the hallways, and doorways being placed to the side

+ Literature Review n Schonfeld, et al. , (2007) n n Macy and Johnston (2007) n n Bracelets in place of one-to-one observations Rowe (2008) n n recommended an evening walking program quick unit search, whole facility search, outside the building search Moore, Algase, Powell-Cope, Applegarth, and Beattie (2009) n overall framework for the management of the wandering patient

+ Literature Review n Handel et al. , (2010) n n Chung and Lai (2011) n n CMAI statistically significant in elopement prediction Huvent-Grelle, et al. , (2012) n n implemented scripting in ED; decrease of approximately 1. 8% in elopement Most frequent time for elopements between lunch and dinner Handel, et al. , (2014) n Over-crowding can lead to increase in patients that left before treatment was complete

+ Research Design Plan and Tools

+ RESEARCH DESIGN n Quasi-experimental design, with no randomization or control group n n Population n n Pre-test, education, drill, post-test (comparing one group’s before and after results) All nursing, nursing assistant, security staff, and respiratory staff info was collected; all staff received the same education and those on site participated in the drill (n=371) Exclusion criteria n staff on an extended leave, new hires, or those leaving; staff members of the parent organization

+ Setting n Local community hospital, with a busy roadway to one side, surrounded by wooded, hilly areas

+ Interventions n Implement a new education module on elopement and response n Testing pre and post knowledge on Code Silver/Green n Practice Code Green drill n Post-drill education if needed

+ TOOLS & EVALUATIONS n Survey Monkey Pre-survey n Net Learning Education Module n Net Learning Testing Module n Code Amber Adult: Gender live drill n Survey Monkey Post-survey

+ Pre-Survey Monkey platform

+ SURVEY QUESTIONS n How comfortable are you handling a missing patient situation? ( 0= not at all, 10 = greatly comfortable) n What actions do you take when a patient is missing? Describe what you would do. n What is your job role?

+ Code Amber Adult: Elopement Updating the former UPDATING THE FORMER CODE SILVER POLICY MALISSA WILLIAMS, MSN, RN, DNP(C) Malissa williams, MSN, RN

+ Code Amber Adult (Gender) Elopement n n Formerly known as Code Silver n Mobilization of forces when a patient is missing from the hospital n In-patients (admitted or observation) Basic Policy: Exerting reasonable efforts to locate a patient who has left without proper authority; explaining to patient the risks of having left; returning them to the hospital as appropriate

+ Code Amber Adult Goals n Providing a safe environment for ALL patients; n To identify at risk for elopement patients and communicate to all caregivers in a private and dignified manner; n Locating a missing patient as quickly as possible and returning him/her to the care/safety of the unit; n Providing timely and complete information to appropriate individuals (pt’s family, physician, Carroll Twp PD) after initial searching

+ Code Amber Adult Alert(Male/Female) Response (Missing patient) n If missing from the room, immediately check the unit n Verify the time the patient was last seen, where, when and by whom n Notify security at (1212) or hit the button on the top of your wireless n n Security will alert the operator to call Code Amber Adult(Male/Female): Unit/Room May utilize image from chart upon admission n Notify the department manager or Nursing Supervisor (shift dependent) n Notify the MD n Activate the Code Amber Adult Alert Checklist in Meditech n Steps to follow and document so areas are not missed

+ Code Amber Adult: Alert Response Active Search n Call the patient’s cell first, then home phone n n If no answer, proceed to emergency contact, though do not divulge clinical information Special Considerations: Suicide/Violent Behavior Risk n n n Emergency contact notified immediately Provide description to police Notify Crisis Intervention If threats made about any individual, the police notify that individual Media Relations will determine any need to discuss situation with media

+ Code Amber Adult: Assessing Learning Malissa Williams, MSN, RN, DNP(c)

+ Questions or Feedback?

+ References Bowers, L. , Jarrett, M. , Clark, N. , Kiyimba, F. , & Mc. Farlane, L. (1999). Absconding: why patients leave. Journal of Psychiatric and Mental Health Nursing, 6, 199205. Chung, J. C. C. , & Lai, C. K. Y. (2010). Elopement among community-dwelling older adults with dementia. International Psychogeriatrics, 23(1), 65 -72. Fuoco, A. F. (2010, July 23). Family of woman frozen on UPMC roof to receive $900, 000. Pittsburgh Post-Gazette. Retrieved from http: //www. postgazette. com/breaking/2010/07/23/Family-of-woman-frozen-on-UPMC-roofto-receive-900 -000/stories/201007230144.

+ Handel, D. A. , Fu, R. , Daya, M. , York, J. , Larson, E. , & Mc. Connell, K. J. (2010). The use of scripting at triage and its impact on elopements. Academic Emergency Medicine, 17(5), 495 -500. Handel, D. A. , Fu, R. , Vu, E. , Augustine, J. J. , Hsia, R. Y. , Shufflebarger, C. M. , & Sun, B. Association of emergency department and hospital characteristics with elopements and length of stay. The Journal of Emergency Medicine, 46(6), 839 -846. Huvent-Grelle, D. , Delabriere, I. , Roche, J. , Jacquet, C. , Dulys, D. , & Puisieux, F. (2012). Elopement evaluation on Alzheimer disease patients in France. The EVADE study. Journal of Aging Research & Clinical Practice, 1(1), 51 -55.

+ Logsdon, R. G. , Teri, L. , Mc. Curry, S. M. , Gibbons, L. E. , Kukull, W. A. , & Larson, E. B. (1998). Wandering: A significant problem among community-residing individuals with Alzheimer’s disease. Journal of Gerontology, 53 B, (5), 294 -299. Macy, D. , & Johnston, M. (2007). Using electronic wristbands and a triage protocol to protect mental health patients in the emergency department. Journal of Nursing Care Quality, 22(2), 180 -184. Moore, D. , Algase, D. , Powell-Cope, G. , Applegarth, S. , & Beattie, E. (2009). A framework for managing wandering and preventing elopement. American Journal of Alzheimer’s disease and Other Dementias, 24(3), 208 -219.

+ Rowe, M. (2008). Wandering in hospitalized older adults. American Journal of Nursing, 108(10), 62 -70. Schonfeld, L. , King-Kallimanis, B. , Brown, L. M. , Davis, D. M. , Kearns, W. D. , Molinari, V. A. , Werner, D. H. , Beattie, E. R. , & Nelson, A. L. (2007). Wanderers with cognitive impairment in Department of Veterans Affairs nursing home care units. Journal of the American Geriatrics Society, 55(5), 692 -699. Sherman, J. L, & Silver, J. D. (2008, December 4). Patient, 89, found dead on hospital roof. Pittsburgh Post-Gazette. Retrieved from http: //www. post -gazette. com/local/city/2008/12/04/Patient-89 found-dead-on-hospitalroof/stories/200812040446.

+ Zeisel, J. , Silverstein, N. M. , Hyde, J. , Levkoff, S. , Powell Lawton, M. , & Holmes, W. (2003). Environmental correlates to behavioral health outcomes in Alzheimer’s special care units. The Gerontologist, 43(5), 697 -711.