MISSING AND ABSCONDED PATIENT PROTOCOL · If deemed necessary the security officer will assist / escort the Missing Person back to the department / ward. If the patient continues

MISSING AND ABSCONDED PATIENT PROTOCOL

2.0

Response to missing/absconded Patient

EQUALITY IMPACT The Trust strives to ensure equality of opportunity for all both as a major employer and as a provider of health care. This policy has therefore been equality impact assessed by the Trust Internal Safeguarding Board to ensure fairness and consistency for all those covered by it regardless of their individual differences, and the results are shown in Appendix 5.

Version: 2.0 Authorised by: Trust Internal Safeguarding Board Date authorised: 25th September 2015 Next review date: September 2017 Document author: Head of Security

TAMESIDE HOSPITAL NHS FOUNDATION TRUST Missing and Absconded Patient Protocol

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See Trust Intranet for latest version

VERSION CONTROL SCHEDULE Missing and Absconded Patient Protocol Version : 2.0 - Final

Version Number Issue Date Revisions from previous issue

1.0 Final 07/11/2013 Original Issue

2.0 Identification of risk level in patients presenting to the Emergency Department

Guidance on assigning risk level to patients who leave prior to care/treatment being completed

Actions to be completed after risk level is determined

Guidance on what actions are required for patients with capacity

High risk patient identification form


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TABLE OF CONTENTS EQUALITY IMPACT ........................................................................................................ 1 1. INTRODUCTION ...................................................................................................... 4 2. PURPOSE................................................................................................................ 4 3. DEFINITIONS .......................................................................................................... 4 4. LOCKED DOOR POLICY ......................................................................................... 4 5. DUTIES .................................................................................................................... 5 6. ASSESSING RISK ................................................................................................... 5 7. ON ADMISSION (EMERGENCY DEPARTMENT ONLY) ......................................... 5 8. ACTIONS FOLLOWING SUSPICION OF MISSING PATIENT (See Appendix 2) ..... 6 9. CONTACTING THE POLICE ................................................................................... 7 10. DEVELOPMENT & CONSULTATION ...................................................................... 7 11. IMPLEMENTATION ................................................................................................. 8 12. MONITORING .......................................................................................................... 8 13. APPENDICES .......................................................................................................... 8 14. REVIEW ................................................................................................................... 8

Appendix 1 ................................................................................................................... 9 Appendix 2 ................................................................................................................. 10 Appendix 3 ................................................................................................................. 10 Appendix 4 ................................................................................................................. 12 Appendix 5 EQUALITY IMPACT ASSESSMENT TOOL ............................................ 13


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1. INTRODUCTION 1.1 Tameside Hospital NHS Foundation Trust has a duty of care to ensure the

safety of patients in its care and takes all possible steps to do so.

1.2 Many patients who leave the ward areas / departments do so of their own free will and as a matter of choice and are free to do so. However patients who leave the ward or other departments without the knowledge of staff, cause anxiety and distress to all.

1.3 This protocol provides guidance for occasions when a patient has left an area and cannot be located, to ensure a prompt and systematic response in order to minimise the risk to the individual.

1.4 This protocol has been developed jointly with Greater Manchester Police to ensure clarity and consistency with regard to requests for Police responses. This protocol describes how the Trust will engage with the local Police in the event where ther is a real concern for a patients safety who has gone missing.

1.5 This protocol should be read in conjunction with the following:

Safeguarding Children Policy

Safeguarding Adult Policy

Infant / Child Abduction Policy

2. PURPOSE

2.1 The purpose of this protocol is to ensure an effective and co-ordinated

response in the event of a patient going missing from any clinical areas at Tameside Hospital NHS Foundation

3. DEFINITIONS

3.1 High Risk Patient, will include:

Patients who lack capacity and where interventions are omitted or required.

Patients under a section 136 of the Mental Health Act

Patients who have been assessed as having additional safeguarding concerns or potential risks

Those under the age of 16

4. LOCKED DOOR POLICY

4.1 The Trust Security Strategy ensures that measures such as door access controls are incorporated in ward areas to ensure that the Trust provides the best protection for its patients, staff, and property.


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4.2 Where this is the case, vulnerability of patients should be considered and a ‘locked door pro-forma’ completed (see Appendix 4)

4.3 The Locked door pro-forma should be retained in the patient’s notes

5. DUTIES

5.1 Managers are responsible for ensuring that appropriate education and training is provided for all staff under their control and that the information contained in this policy is cascaded to the appropraite staff groups. Managers must ensure that staff are aware and use the clinical interventions and safety processes in place to minimise the risk of patients absconding e.g. access controls

5.2 Staff must remain vigilant and report any concerns immediately to their team leader and ensure that an incident reporting form is completed, and that they follow the correct procedures listed in this protocol. Staff must adhere and be aware of the clinical interventions and safety processes in place to minimise the risk of patients absconding e.g. access controls

5.3 Security Staff must carry out a thorough search of site when requested

(Security Officers and use of CCTV), and keep in regular contact with the department reporting the missing patient

6. ASSESSING RISK

6.1 Included in Appendix 1 is the risk indicator that must be used to determine the risk level of the patient.

6.2 The risk Indicator will allow staff to:

Appropriately categorise a missing/absconded patient. If there is any doubt, the senior doctor/nurse must be consulted

Have clear and appropriate communication to the Police with regard to the level of concern

Assist Police in prioritising their responses and the allocation of their resources

6.3 When the risk category has been determined follow the procedure for missing patients as detailed in section 8 and Appendix 2

7. ON ADMISSION (EMERGENCY DEPARTMENT ONLY)

7.1 On admission Patients presenting and categorised as high risk (i.e. those who if they left the department would be at risk of harm to themselves or someone else) staff must record demographic details including description, phone number and next of kin information and retain this in the patient’s notes. (See Appendix 3)

7.2 High risk patients must be seen and given high triage priority by a senior clinician so that a review can be undertaken quickly.


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7.3 Should a high risk patient appear to be missing then the following actions MUST be followed :

8. ACTIONS FOLLOWING SUSPICION OF MISSING PATIENT (See Appendix 2)

8.1 Any member of staff suspecting that a patient is missing from the ward should

inform the Nurse Team Leader/ Nurse in Charge immediately. They will then:

Obtain a full description of the missing patient (clothing etc.)

Initiate a search of all rooms and spaces including, linen rooms, store cupboards, toilets, bathrooms, day rooms and plant etc. within the ward/departmental area.

Ward staff should check if personal belongings are missing.

Ask other patients on the ward should be asked if they are aware whether the missing patient had indicated where they may be going.

8.2 For any child or young person that goes missing, immediate liaison with the Police is required. A decision would be made in relation to referral to Children’s Social Care, as protective factors would need to be ascertained. If there are any child protection concerns, refer to the Safeguarding Children Policy

8.3 If the Patient is not found

The Nurse Team Leader/ Nurse in Charge will then undertake the following action:

Attempt to contact the patient via their home telephone

Attempt to contact the patients next of kin via telephone

Inform security and ensure a structured search of hospital grounds is done – (Get description, time of leaving and direction of travel from security)

8.4 Searching

Security will carry out the following

Record as much, accurate and relevant, information as possible from the reporting source and record it on Daily Report Book and Trust Safeguarding Incident database.

The Security Supervisor will despatch security officer(s) throughout the site as required, and commence a CCTV search immediately.

8.5 Successful Search & Find, if patient is found security will:


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Inform the ward/department that Missing Person has been found & their location. Attempt to persuade the Missing Person to return to the department / ward.

If the Missing Person refuses, the security officer will remain with the missing person until a member of the department / ward attends.

If deemed necessary the security officer will assist / escort the Missing Person back to the department / ward.

If the patient continues to try to abscond then the security officer can consider using restraint or keep Missing Person under surveillance.

8.6 Unsuccessful Search & Find, if the patient is not found :

If the missing patient is not located after two complete internal and external searches / patrols have been completed, the department / ward will be informed.

If the patient has been identified on CCTV, however they have left site, give details of description of patient, time of leaving and direction of travel from security)

The patrolling security officers will continue to be vigilant for the Missing Person and will pass the details of the Missing Person to any subsequent shifts.

9. CONTACTING THE POLICE

9.1 The Police should only be contacted if there is a real concern once the above

actions have been completed. The Nurse Team Leader/ Nurse will contact the Police and give the following information:

Surname / Forename / Sex

Date of Birth <13 years of age or functioning <13 with learning disabilities

Time and place booked in and time and place last seen

What are the circumstances leading to the report?

What is the specific concern in this instance?

What enquiries have been made so far?

What would you like police to do on finding this person? (Is this within police powers?)

10. DEVELOPMENT & CONSULTATION

10.1 This protocol was developed in conjunction with Greater Manchester Police


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11. IMPLEMENTATION 11.1 This protocol will be implemented in the Trust, and will be available on the

Trust’s Intranet web site.

12. MONITORING 12.1 The Security Management Group will monitor the implementation of this

protocol.

13. APPENDICES 13.1 Appendix 1 Risk Indicator for Missing/Absconded Patients 13.2 Appendix 2 Concern / Missing Patient Flow Chart 13.3 Appendix 3 Missing/Absconded Pateint Report Form 13.4 Appendix 4 Locked Door Pro-forma 13.5 Equality Impact Assessment Tool

14. REVIEW 14.1 This protocol will be formally reviewed 2 years after first

approval/implementation, or earlier depending on the results of monitoring.


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Appendix 1

Risk Indicator for Missing/Absconded Patients The purpose of the following categorisation framework is to:-

Assist staff to appropriately categorise a missing/absconded patients, if there is any doubt a senior doctor and senior nurse must be consulted.

Allow for clear and appropriate communication to the Police with regard to levels of concern.

To Assist Police in prioritising their responses and the allocation of their resources. When the risk category has been determined follow the Algorithm for Missing/Absconded Patients and complete the complete missing/absconded patient form for high risk patients.

HIGH RISK

Is the patient acutely or chronically confused? i.e. dementia

Is the patient vulnerable i.e. due to age; under 16 (general health), under 18 (mental health), or elderly?

Is the patient deemed not to have capacity? You need to consider if they have: • An impairment or disturbance in the functioning of the mind or brain, and an inability to make decisions. A person is unable to make a decision if they cannot: • understand the information relevant to the decision, • retain that information, • use or weigh that information as part of the process of making the decision, or communicate the decision.

Is the patient suffering from a mental health problem and is an immediate risk to themselves or others? The CPN must be consulted when categorizing a patient presenting with a mental health problem.

Has the patient taken a potentially lethal overdose that needs monitoring or treatment?

Is the patient suffering from an injury or illness that requires urgent/lifesaving medical attention or treatment?

Has the patient suffered a significant head injury or left without having a head injury assessed?

ACTION Police (101) ‘Concern for Welfare’

Complete Missing/Absconded Patient Form (Appendix 3)

LOW RISK LOW RISK LOW RISK LOW RISK

If the patient deemed to have capacity i.e. considered to be able to refuse treatment.

Has the patient been a victim of domestic assault, and is there a concern there will be a repeated assault? Complete MARAC/Child Safeguarding referral if appropriate

Are you concerned that the patient has not made it home safely, but does not need to return for treatment?

Was the patient appropriate for discharge i.e. normal blood results?

Did the patient leave without discharge information or medication?

Has the patient left the department with a cannula insitu? Consult district nurses to visit patient if you are unable to contact the patient directly.

Was the patient suitable for self-care or deflection? ACTION

No Police involvement Contact patient/patient’s GP if necessary

This is not an exhaustive list …

LOW RISK


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Appendix 2

Concern/Missing Patient On admission high risk patients must have demographic details including description, phone number and next of kin (NOK) recorded. This information must be retained in the patient’s notes (see Appendix 3). In addition High risk patients must be seen within their triage priority by a senior clinician. Agreed clinical interventions and assessments should be initiated for individuals who present with immediate risk of harm and may abscond

Discovery of a patient that has left the department without completing assessment or treatment Identify if the patient is HIGH or LOW risk, refer to indicator list over leaf.

(If you are unsure involve Nurse in Charge (NIC), Senior Nurse and or the clinician in this decision)

Is the patient HIGH risk?

No Yes

1. Inform NIC/Senior Nurse that patient is confirmed as missing. 2. Inform Security and relay Important Patient Information (TABLE 1) to

Security. 3. Attempt to contact patient via documented telephone number or next of kin

if appropriate.

1. Inform the NIC/Coordinator that you suspect a patient has absconded. 2. Perform local check of the department to attempt to locate the patient.

Advise patient not to leave the clinical area

without informing a member of staff first.

Patient Found

No

Yes

LOW RISK 1. If the patient has left before being

seen with a low risk illness or injury document and discharge as ‘Did not wait’.

2. If the patient left without routine information or TTO attempt to contact the patient via telephone and document result and inform clinician who can inform the GP if needed.

3. If the patient has left with a cannula insitu attempt to contact the patient. If you are unable to contact the patient make an urgent district nurse referral. DO NOT CONTACT THE POLICE. N.B. For LOW RISK missing/absconded patients a missing/absconded patient form does NOT need to be completed.

HIGH RISK 1. Call police on 101 2. Explain circumstances and state that there is a ‘concern for the patient’s welfare’. 3. Relay Important Patient Information to the call handler, and document the log number.

4. HIGH RISK should be brought back to the department if they lack capacity. 5. HIGH RISK with capacity should be brought back to the department if agreeable and appropriate. 6. Complete missing/absconded patient form and return to the missing/absconded patient file. 7. Document details in nursing documentation. 8. Complete Incident Form

Patient Found 1. Inform NIC, clinician and police (if they have not returned them) that the patient has returned. 2. If patient has returned they must be booked back into the ED. 3. Update the missing/absconded patient form, in the missing/absconded patient file located in majors.

TABLE 1 - Important Patient Information 1. Time/Place last seen in department 2. Patient description:

Age

Gender

Height

Hair colour

Skin colour

Description of clothing

Distinguishing features/behaviour 3. Any escorts/NOK with patient 4. Clinical condition/information 5. Does the patient have the capacity to refuse treatment 6. Does the patient need further clinical treatment or assessment


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Appendix 3

MISSING/ABSCONDED PATIENT REPORT FORM

PATIENT DETAILS ***(Inform Security of concerns)

Patient Name

NHS number

Patient Address

Telephone number

NOK Contact details

Description of Patient:

Age Male Female

Ethnicity

White Black Mixed Race Asian Chinese Other

Hair Colour: Hair Length:

Eye Colour: Glasses: Distinguishing Marks:

Build Any other Information

Actions Attempt to contact patient via phone Attempt to contact NOK via phone

Action Inform security and ensure a structured search of hospital grounds is done. Ask Security to provide the following information:

Has the Patient been located

Are they still on site or have they left?

To provide further identifiable information, for example: what colour coat/hair colour etc.

If see leaving site, what time? and what direction?

If there is a real concern once the above actions have been completed and/or considered please have the following information ready for the police call handler

1. Surname / Forename / Sex 2. Date of Birth. If less than 13 years are they <13 years of age or functioning <13 with learning disabilities 3. Time and place booked in and time and place last seen 4. What are the circumstances leading to the report? 5. What is the specific concern in this instance? 6. What enquiries have been made so far? 7. What would you like police to do on finding this person? (Is this within police powers?)

Police Informed

Time: Log number:

Person completing the form Time: Date:

Outcome (to be completed by Team Leader

RETAIN THIS DOCUMENT IN THE PATIENT NOTES


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Appendix 4

Closed Access Policy

Patient Details:

Name: Ward:

NHS Number: Date:

Named Nurse: Time:

Mr/Mrs/Miss is currently being nursed within an area, which operates a closed access Policy. The principal aim of restricting the client's exit from the unit is to maintain safety in accordance with the Trusts duty of care and other possible legal frameworks (e.g. Mental Health Act 1983 and DOL’s). The decision to care for the patient within a closed ward environment will be reviewed by the named nurse and the multidisciplinary team The stated minimal actions should be considered in conjunction with the individual care plans, to ensure their safety and to provide appropriate supervision as required.

Key Safety Actions

1. Referral to RAID

2. Supervision methods

3. Medication Review

4. Notification of family/carers

5. Assessment of capacity

6. DOL’s referral

7. No action required - Discussed with Patient

Signature of Named Nurse


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Appendix 5

EQUALITY IMPACT ASSESSMENT TOOL

Yes/No Comments

1. Does the policy/guidance affect one group less or more favourably than another on the basis of:

Race No

Ethnic origins (including gypsies and travellers)

No

Nationality No

Gender No

Culture No

Religion or belief No

Sexual orientation including lesbian, gay and bisexual people

No

Age No

Disability - learning disabilities, physical disability, sensory impairment and mental health problems

No

2. Is there any evidence that some groups are affected differently?

No

3. If you have identified potential discrimination, are any exceptions valid, legal and/or justifiable?

N/A

4. Is the impact of the policy/guidance likely to be negative?

No

5. If so can the impact be avoided? N/A

6. What alternatives are there to achieving the policy/guidance without the impact?

N/A

7. Can we reduce the impact by taking different action?

N/A

Documents

MISSING AND ABSCONDED PATIENT PROTOCOL · If deemed necessary the security officer will assist / escort the Missing Person back to the department / ward. If the patient continues