February 27, 2015 Page 1

Do you know what Group Health’s doing to manage a missing patient/medically at-risk person?

Strategy:To establish a procedure to ensure that missing patients/medically at-risk people are searched for and, if not found, police are contacted. Goal is to rapidly deploy while protecting patient confidentiality.

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Purpose:Possible Code Purple: Patient walking away and/or discovered to be missing – may be used for a potential at-risk patient companion, escort, or designated care partner.

There have been recent cases where patients have wandered off and staff were not sure how to go about organizing a search party and deciding if/when to contact local police to assist. Normal code protocols cannot be used due to a need to protect patient confidentiality. As a result, each facility has been asked to design a unique Code Purple procedure. Below is the proposed procedure for your facility. Please work with facility leadership and CBRE Facilities if you think of improvements or other options.

Planning: Due to variations in facility set-ups and services offered, each facility will need to design a response team and a method for disseminating appropriate information to all appropriate locations. This should be done in a manner that will protect patient confidentiality while providing a response team with enough information to find the person in question.

Response Team: Each location will need to determine designations and numbers of persons expected to respond to the code. Note:

  • Does not need to be a large number of people.
  • A sufficient numbers of responders need to be familiar with the code process to assure sufficient numbers do respond based on the size and complexity of the Medical Center

The response team at this facility is (Describe the team):

Calling the code: Potentially sensitive information must not be broadcast overhead. After the code is called (no confidential information given), the response team will need to determine how to disseminate a description of the missing person. It may be:

  • Word of mouth in small facilities;
  • Established phone trees; or
  • Location specific broadcast email (If email is used, then the all clear must also be sent by email as well as overhead broadcast to avoid confusion for persons logging into email at a later time).

Describe how code will be called and how information will be disseminated to the response team:

All Hands: When a code is announced, all available staff must be alert for persons in their immediate area that may appear lost or disoriented.

  • Tactfully determine if the person needs assistance
  • Anticipate follow-up descriptive information via the established information dissemination method described above.

Contacting Police: Time may be of the essence when considering the risk or vulnerability of the missing person.

  • If a responsible party is present that can make decisions on behalf of the missing person, they should be part of the decision to contact police.
  • If there is no contact with a responsible companion or family member, decision should based on risk to person if lost, how long it has been since the person was last seen, and if a reasonable search of the immediate and logical area has produced no success.

Procedure

All Staff / Call Code Purple using the method described above. Staff to be alert for persons appearing lost or disoriented. Follow plan above.
Designated Staff / Designated Manager/Supervisor, Security if available, engineering if available, Custodians if available, and members of safety committee respond to scene to assist. Senior or most appropriate party assumes incident command.
Unit Staff / Available staff participate in checking surrounding units, stairwells, and areas. Report any pertinent information that may be useful in locating a missing person and assisting in assessment of risk.
Response Team / Determines answers to pertinent questions such as:
  • How long has the patient been missing?
  • Description?
  • Is there a medical hold on the patient?
  • Is the patient a known risk for wandering or elopement?
  • Is the patient a known smoker?
  • Is there specific risk – potential harm to self or others or health condition?
  • Is the patient incapacitated in any way that may compromise thought process?
  • Does patient have an emergent, acute, or life-threatening condition?
  • Are there safety reasons that the patient must be returned to the unit?

Available Staff / Response team communicates description to staff and expands search of all areas including appropriate exterior (up to 250 yards at Emergency Medical Triage Act (EMTALA) qualified locations).
Response Team Leader/Incident Commander / Document all related information including, events leading up to missing discovery/reporting, description, specific health or behavioral concerns, and search functions. A sense of urgency must be applied to escalation or response.
Reasonable delay should be based on size and scope of the facility and potential the person has moved to the surrounding community
Consider:
  • Calling patient’s most appropriate phone number, if available.
  • Calling emergency contact.
  • Calling police for notification or potential welfare check if enough time has elapsed for patient to arrive home or to assist in search if situation warrants.
  • Assigning spokesperson to keep appropriate parties informed.

Attending Care Giver / Document all pertinent health related information and if there is no emergent, life-threatening condition warranting patient retrieval, concluding facts that may indicate patient left on own accord and/or against medical advice.
Team Leader/Incident Commander / If search is unsuccessful, notify Risk Management and Communications.
All Staff / If patient is located, maintain visual contact until response team member arrives. Offer assistance, if appropriate.
Response Team Member / If appropriate, staff are to encourage patient to return to care unit and consider discussing procedures for leaving against medical advice.
Appropriate staff or caregiver / If patient returns:
  • Assess patient.
  • Document findings.
  • Determine whether patient is continued risk for wandering/elopement.
  • Determine plan to deter future attempts.
  • Consider healthcare agreement for managing behaviors.
  • If patient is at risk for self-harm or harm to others determine measures such as involving social worker.
  • Educating patient and/or dedicate personal care giver about the risk of leaving against medical advice.
  • Clear code.

Incident Leader / If patient declines to return:
  • Assess potential risk to self or others.
  • Assess expectation of return versus allowance to leave (is there a compelling mandate).
  • Assess need for Mental Health professional contact.
  • Determine if Code Gray procedure is appropriate.
  • Determine if law enforcement assistance is warranted.
  • Clear code if appropriate.

Incident Leader /
  • Advise Risk Management and Communications of outcomes.
  • Conduct a debrief as soon as possible to identify gaps and successes.
  • Insure that all appropriate parties provide documentation of event.
  • Consider discussion with appropriate family or designated personal care giver regarding risk of leaving against medical advice.

Questions? Contactat;

Facility Managerphoneemail

February 27, 2015 Page 1