Elopement is defined by the National Institute for Elopement Preventionand resolution as, “When a patient or resident who is cognitively, physically, mentally, emotionally, and/or chemically impaired; wanders away, walks away, runs away, escapes, or otherwise leaves a caregiving facility or environment unsupervised, unnoticed, and/or prior to their scheduled discharge.” When a patient elopes it can lead to significant injury and/or suffering and cause stress to both the staff and the family.
Adults with a history of Alzheimer’s disease and/or dementia are at risk for wandering and elopement. Because this could result in an injury or fatality, consider evaluating existing organizational protocols and strategies for elopement prevention. If cost is a concern for an organization, there are inexpensive devices that could be used to help prevent elopement or wandering. For example, a simple hardware-store chime or buzzer could be installed on a rear door that would alert an attendant when the door has been opened.
In years past, wandering and the potential for elopement would typically be addressed with chemical and/or physical restraint. New standards of care emphasize patient rights and a “restraint-free” environment. Evaluating how a long term care or residential facility is addressing these issues can help keep their patients safe.
Identification and Assessment of Those at Risk
The first step in elopement prevention is to identify residents who may be at risk to wander or elope. Elopement risks are generally greatest in the first 72 hours following admission. It is important, therefore, to recognize those characteristics that can be used to identify a resident as a risk to wander and/or elope during the initial admission assessment. The assessment process, if done prior to admission to the facility, may help determine whether the organization is capable of properly and safely addressing the resident’s care needs.
Ask families and/or significant others if the resident has a history of wandering or becoming disoriented. A reported history of wandering helps demonstrate that an increased risk of elopement exists and additional supervision and other precautions may be indicated. If there is a history of wandering, some additional questions that could be asked include:
- When did the wandering behavior begin and how frequently does it occur?
- Is it more frequent in daytime hours or at night?
- Is the wandering associated with other factors such as noise or discomfort/pain?
- What type of travel pattern is exhibited (random, pacing, lapping)?
- Does the wandering appear purposeful?
- Assess the resident for cognitive changes and symptoms of anxiety, depression or agitation, since these may lead to erratic behavior, including wandering.
Once a resident has been identified as high risk to wander/elope, it is important that the information is shared with facility staff, not just nurses and other direct patient care providers. Add a risk to wander assessment to ongoing resident assessments.
Strategies for Prevention
Since approximately half of all elopements occur within the first days of admission as residents are adapting to their new environment (Alzheimer’s Association, www.alz.org), it is optimal to place new residents in rooms away from exits and closer to community areas, providing them with less opportunity to elope. If this is not possible, it is important staff be extremely vigilant in the initial days following admission, until they become familiar with the resident’s behavior patterns and the resident becomes familiar with their new surroundings.
Some items to consider on a residents care plan include:
- Focus on safety and management of the wandering behavior.
- Institute “whereabouts” checks so that staff can account for all residents on each shift at regular intervals.
- Instruct staff to maintain visibility of exit doors, particularly during shift changes and emergencies as these are times when residents may be able to exit the facility unnoticed while staff attention may be diverted.
- Many organizations use electronic devices such as bed and door alarms, video cameras and resident tracking devices to help prevent wandering and elopement. These devices can potentially help reduce the incidence and severity of elopements. Give strong consideration to alarming exit doors from resident care units or directly from resident rooms.
Missing Resident Protocols
It is important to have a missing resident protocol in place so that staff is aware of the procedures to follow, should such an event occur. Some items to look for if evaluating or implementing a protocol include:
- An internal alert system to signal staff if a resident is missing and to implement response procedures. Consider assigning staff to specific areas and using a checklist of searched areas or shading in searched areas on a floor plan.
- A systematic search of resident care units and other immediate areas - this means, rooms, closets and stairwells, even those areas that are normally locked, along with the roof if there is roof access.
- A thorough search of the grounds – alert staff of potential hazard areas such as parking areas, major adjacent roadways or ornamental ponds.
- Notification of management, family members and physician(s).
- Notification of local police to request their assistance.
- Documentation of all actions taken either at the time of the incident or immediately afterward
What to do when the resident is located
- Obtain a complete medical evaluation to identify potential injuries and provide necessary treatment.
- Notify any previously contacted individuals of the resident’s return.
- Conduct an investigation to determine how the elopement occurred in order to correct any underlying contributing factors.
A missing resident can be a significant loss exposure. Preparation for handling a missing resident is as important as preparing for other emergencies. Having a protocol in place and providing adequate staff training are key to planning for this type of event. Make staff aware that reluctance to report a resident is missing and initiating the protocol will not be tolerated. Periodic “missing resident” drills may prove very helpful. The main goal of managing wandering behavior is to protect the resident from serious injury or death. With a focus on assessment, identification and initiation of elopement prevention strategies this goal may be attainable in the residential setting.
Assisted Living Federation of America (www.alfa.org),
“Risk Analysis: Hazardous Wandering and Elopement” (www.ecri.org)
Alzheimer’s Association (www.alz.org)