Med Care. source code, databases, software, and functionality on the Site (collectively “Content”) There is nothing to be ashamed of if you want to elope, and it is 100% up to you whether you tell people now, after the wedding, or ever! No one is “owed” a metaphorical seat on your special day. It shall be the responsibility of the patient/resident requesting the pass to apply sufficiently in advance to allow for all necessary medications to be provided or other preparations to be made. It is helpful if there are criteria specified in the resident's plan of care for when interventions are to be implemented. This process entails a comprehensive, standardized assessment of each resident's functional capabilities and health needs. RESPONSIBILITY
It is the responsibility of the physicians, nurses and the hospital police department to ensure adherence to this policy. CAMPUS PASSES
A. It’s even possible that the person who assumes the worst when you tell them you want to elope doesn’t feel they could do what you’re doing–maybe they’re even already married and wish they had eloped! / 0 1 � � � � � � � t $$If �l � � ���$ �&. The Elopement Work Group viewed the contents of these materials as offering examples of different ways to address the key components of a systems approach to resident unsafe wandering and elopement. Answer: It is difficult to definitively answer the question with a �yes� or �no� response, as the circumstances surrounding the elopement must be thoroughly examined to make such a determination. Couples can share vows at an elopement and a wedding. (The patient/resident can obtain an unexpired pass from hospital police if she/he desires to leave the hospital again.) Is there a special event/anniversary coming due that the resident normally would go to? The financial cost of your wedding has nothing to do with the value of your wedding. Together we engaged in active dialogue and undertook a reviewparticipated ofin reviewing the literature, a variety of assessment tools, and policies and procedures and had active dialogue related to the topic of resident wandering, leave of absence, and elopement. 9 Facilities should consider when a resident is determined "missing." Basically, the best way to not regret your wedding day is to do exactly what feels right for you! Eloping isn’t about the things you’re losing, it’s about what you gain! 2. This residency requirement does allow for interruption due to hospitalization. Truly, we understand how appealing it is to treat a wedding like a reunion, but it’s simply not possible to spend quality time with that many people in one day. Reviewed By: Date:__________________
Reviewed By: Date:__________________
Staff Training
Sample Interventions for
Residents Exhibiting Wandering Behavior
In addition to staff training on the facility�s specific policy related to missing residents, all staff/all departments need to receive training on general interventions to be used on residents seeking to elope from the facility. We are Maddie Mae, Amber, and Tori. The leave is up to two days at a time. Brides began wearing white less than 200 years ago, and the Christian church only began performing marriage ceremonies regularly nearly 500 years ago.I mean, if you go back far enough, anthropologists believe the concept of “marriage” only became normalized around 4000 years ago…but you get the point. Do responses to any of these questions indicate risk for elopement? Were search assignment sheets distributed to staff? Communication such as but not limited to:
Resident photographs at reception desk/exits
Written notification to appropriate departments regarding at-risk residents etc. Page 2 of 5
PROCESS
ResponsibilityActionAll StaffWill notify highest ranking nursing personnel of missing resident
Highest Ranking Nursing PersonnelWill direct unit staff to begin search of unit immediately
Will announce from any telephone, Code 100 by dialing 4444 and repeat three (3) times. Identify triggers indicating resident�s need for walking assistance
Evaluate unit/facility for potential hazards for this resident
Walk with resident after lunch daily on the grounds � family will do this on Saturday and Sunday
Offer resident participa-tion in walking club
Offer resident out of house nature trips, apple picking, leaf looking, etc. In the event of resident elopement it is the policy of �������������������������� to implement its policies/procedures immediately to locate the resident in a timely manner. The head/charge nurse shall issue the patient a pass. Did all staff remain on heightened alert? The Minimum Data Set (MDS) is part of a federally mandated process for clinical assessment of all residents in Medicare or Medicaid certified nursing homes. 20. The nurse will inform the interdisciplinary team if the patient does not adhere to the pass policy, and will document this in the medical record. lead to the wandering? One factor to consider is whether system issues have contributed to the elopement. We are distributing this resource manual free as a member service. Did CNA staff notify NM immediately after resident was discovered missing? This form will be submitted to medicine and nursing. Answer: Immediately. xX20,; and Nancy Tucker at New York Association of Homes & Services for the Aging (NYAHSA) (518) 449-2707 ext. Accompanying family/person will sign the pass and assume responsibility for the patient�s safety. Did NM call switchboard operator to announce Code 100? Assessments are conducted by trained nursing home clinicians on . Has the resident received care in a specially designed therapeutic unit? What will [insert family member] think?”. The goal of each assessment is to elicit specific information from that resident to ensure an effective, individualized plan of care can be initiated and evaluated. Did NM/charge nurse update CCP to attempt to prevent further occurrences? If the resident makes the decision to stay away longer than what was originally told to the facility he/she has that right and, consequently, the DOH does not need to be notified, as long as the facility knows the whereabouts of the resident. “Eloping looks so cheap, you should invest in your wedding day because it’s important!”. Most couples aren’t eloping to cut out any individual, but they might be wanting to cut out the stress of hosting a big event, and that distinction should alleviate the personal hurt your loved ones might feel at this decision. B. The task force recommends that these questions are asked of the resident/family/significant others at preadmission, upon admission, quarterly and with any new behavior related to exit seeking activity. Is the resident exhibiting restlessness and/or agitation? 6. The materials included in the resource manual are those that this group agreed provide the most useful examples that currently exist. Administrator/Director of Nursing/Designee
Notifies D.O.H. POLICY
As part of admission assessment, all newly admitted Patent�s/Resident�s clinical status will be assessed by a registered nurse to determine their risk for wandering using the Wandering Risk Scale form. Page 3 of 6
B. All residents will have a mechanism for being identified, i.e., name bands and compliance will be monitored. Examples:
�I have to go meet my son�s school bus�. 1. BUT WAIT–those studies are all older and don’t take into consideration the fact eloping is different now than it was even a decade ago! A. Patient/Resident Return:
1. “But it’s traditional to get married with your family present! Requests for authorization for multiple-day passes shall be reviewed once a month by the team to evaluate any change in condition. Follow @adventureinstead and show how you #adventureinstead in your life. d) to notify the Department of Nursing if a patient/resident attempts to or leaves the hospital without a pass. (date, day of week, time)What area/service was impacted?Why did it happen?The process or activity in which the event occurredWhat are the steps in the process, as designed? Sugar on a joint group. Wedding traditions look different depending on religion, culture, economics, and social norms. Does the resident verbalize a desire to leave? The bed alarm will be utilized on the resident while they are in bed. Windows
Doors
Stairs
Elevators
other corridors
Exterior
Doors to the Exterior
Supervision � are doors located in an area that permits staff supervision? The nursing unit shall reflect the return time in the medical record. If this is the response to your elopement announcement, don’t take it too personally. The head/charge nurse will process the campus pass and document the patient�s departure in the medical record accordingly. If you scour the internet for blogs and forums dedicated to the question of “should I tell my family I’ve decided to elope,” you will find a lot of advice suggesting you wait until after the elopement to announce your marriage, or that you avoid posting on social media so people don’t get offended. Appropriate staff will monitor resident whereabouts including the monitoring of responses/reactions to events/activity in surroundings at time of wandering and report unusual behaviors to supervisor immediately. Days of Absence - Accounting of days chargeable against a calendar year balance; computation will include day of departure, but not day of return. Did each NM conduct a head-to-head search in their neighborhood to make sure that missing resident is not in their neighborhood? In the event of resident elopement it is the policy of �������������������������� to implement its policies/procedures immediately to locate the resident in a timely manner. In the event that the physician/RPA determines that the patient is permitted daily renewal of the pass privilege, a separate pass still must be issued each day by nursing to enable the nursing staff to observe any change in the patient�s condition. Consistent with New York State regulations (NYCRR 415.3(h) and DOH Interim Policy for Transfer/Discharge of Nursing Home Residents, effective 5/1/04) and facility policy, leaves of absence for patients/residents are authorized under the following conditions:
Nursing Facility:
1. 6. Answer: The facility would need to conduct a system-based analysis, which some identify as a root cause analysis, on any elopements where the resident was able to exit the facility without staff knowledge. Because each event will involve a multitude of factors/variables, arbitrary criteria cannot be applied in defining what is a citable situation. Eligible residents will request a day pass at least 24 hours in advance. To establish guidelines regarding the right to return to the residential environment upon termination of an authorized leave of absence or pass. Obtain �wandering� history/patterns from family
Provide with coffee, pastry, and newspaper each morning in lounge area and wine/cheese and crackers in dining room before supper
Show resident �Field and Stream� videos/ magazines or family albums/videos when he appears overly tired from walking
10.Encourage resident to participate in the above activities
11.Wanderguard bracelet on right armNursing/team
Nursing, Activities, SS, PT
Nursing, PT, Activities, SS
Mon. PURPOSE
To assure the safety and security of all residents
To establish policies and procedures in the event of a missing resident
To train and maintain staff awareness of the importance of resident safety and security
ELOPEMENT RESPONSE TEAM
The members of the Search Team include the following:
During normal business hours Department Heads, Supervisors, Security report to Administrative office. Every instance of elopement is considered on a case-by-case basis as to whether a resident was placed at actual or potential risk for harm related to an elopement episode. General interventions may include:
Validate the resident�s concerns. Utilize the facility�s policies, procedures and standards to assist in evaluating the effectiveness of these facility standards and to keep the process simplified. DEFINITIONS
This policy applies to situations in which the resident desires to leave the facility or the campus for one or more days for reasons other than to attend facility initiated or facility authorized activities, i.e., recreational or other trips accompanied by facility employees, approved continuing education, etc. All Rights Reserved. Each time the patient/resident makes a leave request, the nurse must also check the daily patient log/report to ensure that only one pass per day is given. It’s true–if you want to elope & don’t, you’re way more likely to regret the traditional wedding. Whatever reason you want to elope is valid, period. Does wandering behavior lead to difficulties dealing with people and coping in the facility? Should the physician/RPA determine that a pass should be issued for one or more days, this order shall be noted in the �physician�s order� section of the medical record. You aren’t doing this to cut them out (or maybe you are, but that’s a whole separate conversation), and explaining all the different things you gain by eloping will open their eyes to the fact this simply isn’t about them. Does the resident accept their current residency in the facility? “It breaks my heart that you don’t want me at your wedding.”. Did NM/charge nurse update CCP to attempt to prevent further occurrences? This can be one of the most frustrating objections to respond to–how can anyone know what you’re going to regret in the future?! Page 1 of 2
Behavior Resident Assessment Protocol (RAP)
For residents who trigger on the MDS due to wandering behavior,
this is an unofficial revison of the CMS Behavior RAP. Internet Resources 2. Page 5 of 5
Staff ResponsesYESNON/ADid Department Heads/Designee report to command post after announcement of code 100? Assess Patient/Resident in the following areas:
Mental status
Mobility
Speech patterns
History of wandering
Diagnosis of dementia
Write the score of 0, 1, 2, 3 or 5 for each parameter that best describes the Patient�s/Resident�s condition. The appropriate Day Pass Form must be completed and a copy maintained by nursing until the resident�s return. Monitor the effectiveness of the environmental methods used to prevent elopement on a periodic basis. In such cases, the facility needs to conduct an internal review to determine if facility practices, or failure/lack of them contributed to the resident leaving the building, and what potential or actual harm occurred. 9. Policies should indicate when an elopement is reported to the Department of Health and other authorities. Is the onset of wandering behavior associated with start of a medication? Many traditional weddings result in the couple getting married barely spending any time together! Does this have to be called into the DOH? Yes, some elopement marriages will end in divorce. � � ���� � � � � � � � � � � �������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������� M �� qL bjbj�=�= 0x �W �W �B e �� �� �� l � � � � � � � T 6 �� �� �� � >� � �� � 6 �, h �� : �� | x� x� x� � � � �+ �+ �+ �+ �+ �+ �+ $ E. e0 � �+ � � g j � � � �+ C � � x� x� � �+ � C C C � � p x� � x� �+ C � �+ C � C � � �� � R � � � x� �� �lHR�b�6 p� �� � � �� � � # q, l �, ~�
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