Newly admitted residents frequently seek to “go home” and should be carefully monitored until they become accustomed to their new environment. Also, when a resident experiences a new feeling of confusion due to a change in their mental status, they frequently seek to escape in order to relieve their frustration and mental disorientation. This desire to flee is termed “elopement” and is a high-risk topic in long term care circles. News sources like McKnight’s frequently report on residents who find ways to elope, and all too often the results are deadly and devastating to the resident, their families, and the facility that has been given the responsibility for the resident’s care and safety.
Staff must shed themselves of the idea that just because a resident has not previously demonstrated a desire to flee by using the stairs or the elevator as a way out, the very nature of many residents in long term care is transitional and reactive. Transitional is the tendency for an aging resident to decline in mental status, and reactive is how a resident’s mental status can be affected by medications and/or an infection or illness. Instead of a predominant status quo mindset, the process needs to be proactive and questioning – what is a resident doing on the stairs or in the elevator when it is nighttime and most residents are in bed?
If you do not know a resident’s plan of care, do not assume a resident is safe in a location other than where he or she resides. Don’t hesitate to react and prevent a possible endangerment to a resident and a risk for the facility.
I. Risk Exposure: During the night a resident went down in the elevator, and then the front door alarm was heard. A nurse responded and met the resident on the stairs as she was trying to get out. The resident was expressing that she wanted to go home. A nurse had seen her prior to her getting on the elevator and didn’t think much of it as she had no history of exit seeking behavior. The resident was up and about during the night, and her behavior is a significant deviation from her normal baseline.
II. Potential Reason: The resident has confusion, which is new and represents a significant change for the resident. At this point the resident needs directing. She possibly has an infection that is influencing her activity.
III. Mitigation Strategy: The staff placed a wander guard bracelet on the resident. Additionally, 15-minute checks were initiated. The Nurse Practitioner was contacted and ordered a urinalysis and culture and sensitivity. There is a recommendation for the resident’s physician to consider having the resident evaluated at the emergency room, as she is showing evidence of a significant change in her mental status.
IV. Potential F-Tags:
- F323- Accidents and Supervision
V. Performance Improvement/Education: Please consider counseling the nurse regarding the resident’s change of condition and need for supervision. Also consider educating all staff regarding recognizing change of resident condition and the actions to take when that occurs
