1. [PDF] Pharmacist's Manual - DEA Diversion Control Division
Jul 20, 2022 · This Pharmacist's Manual is intended to summarize and explain the basic requirements for prescribing, administering, and dispensing ...
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2. [PDF] Oregon Board of Pharmacy Laws & Rules
Mar 8, 2020 · (5)(a) Upon transferring a drug described in sub- section (2) of this section, the pharmacist, intern or pharmacy technician shall require the ...
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3. Pharmacology and Drug - JeopardyLabs
When distributing a medication to a patient, all of the following is entered into a logbook by the medical assistant EXCEPT ______. a.quantity.
Personal protective equipment includesa.gloves.b.face masks.c.protective eyewear.d.all of the above., Which of the following is one of the sources of drugs?a.Plantsb.Animalsc.Syntheticsd.All of the above, Which of the following is NOT one of the three names used to describe drugs?a.Geneticb.Genericc.Brandd.Chemical, Nonprescription drugs are also known as ________ drugs.a.under-the-counterb.over-the-counterc.prescriptiond.addiction
4. Cardiopulmonary Resuscitation (CPR) - Medscape Reference
Missing: logbook ________.
Cardiopulmonary resuscitation (CPR) consists of the use of chest compressions and artificial ventilation to maintain circulatory flow and oxygenation during cardiac arrest (see the images below). Although survival rates and neurologic outcomes are poor for patients with cardiac arrest, early appropriate resuscitation—involving early defibrill...
5. [PDF] commonwealth of massachusetts - Mass.gov
Apr 10, 2020 · facility policy while in the patient's room. o Facilities should maintain a record (e.g., log book) of all visitors who enter patient rooms ...
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6. [PDF] JUNE 201 55 - Shelby County
Medical staff shall document all treatment efforts in the detainee's medical ... be entered into the Medication Distribution Record in JCS32. F. If for any ...
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7. 1993 Statutes of Nevada, Pages 1801-2000
All lease-purchase agreements heretofore entered into by ... 652.230 The provisions of this chapter apply to all public and private medical laboratories except:.
[Rev. 2/12/2019 2:06:07 PM]
8. [PDF] INSPECTIONS AND APPEALS DEPARTMENT[481]
Jul 2, 2008 · Audits relative to the administration and disbursement of funds under the state supplemental assistance program and the state medical assistance ...
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9. [PDF] Information About the Maryland Register and COMAR - StateScape
Jan 16, 2019 · Except when an individual is enrolled in Medical Assistance but does ... (2) System operators shall record in a logbook all actions to change ...
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10. [DOC] Table of Contents Elopement Resource Manual - nccdp
Enter the dates of assessment and reassessment in the appropriate boxes. Assess Patient/Resident in the following areas: Mental status. Mobility; Speech ...
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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. DOH sent out a Dear Administrator Letter (DAL) recently providing the Executive Summary of the Work Groups activities. ( See(See HYPERLINK "http://www.nyhealth.gov" www.nyhealth.gov) The Associations have compiled the attached resource manual, which is designed to provide helpful samples and to accompany the DAL and the guideline. The resources include a variety of assessment questions, tools, and sample policies and procedures that may assist you in reviewing your current program to define and prevent resident elopement. These have been collected from nursing homes across the State or developed by Work Group members over the past several months. The materials included in the resource manual are those that this group agreed provide the most useful examples that currently exist. We are distributing this resource manual free as a member service. We suggest that you bring your key directors and/ managers together toand review your current program for resident elopement prevention and revise your system if needed. If we can be of any additional assistance, feel free to reach out to any of the following Work Group contactscall us.: Roxanne Tena-Nelson at the Continuing Care Leadership Coalition (CCLC), Greater New York Hospital Association (GNY) (212) 258-5330506-5412,; Debora LeBarron at Healthcare Association of New York State (HANYS) (518) 431-7702,; Nancy Leveille at New York State Health Facilities Association (NYSHFA) (518) 462-4800 ext. xX20,; and Nancy Tucker at New York Association of Homes & Services for the Aging (NYAHSA) (518) 449-2707 ext. xX129. Scott Amrhein Daniel Sisto President, CCLC President, HANYS President, CCLCt of Continuing Care Leadership Collation GNY Dan Sisto President, HANYS Richard J. Herrick Carl Young President & CEO, NYSHFA President, NYAHSA Carl Young President, NYAHSA Names of each key association person. Do we want our names or our CEOs ???? Internet Resources for Elopement and Unsafe Wandering Behaviors Visit the Joint Commission on Accreditation of Healthcare Organizations at HYPERLINK "http://www.jcaho.org" http://www.jcaho.org and find the following useful resources: Forms and Tools: http://www.jcaho.org/accredited+organizations/sentinel+event/se_forms+and+tools.htm Failure Mode, Effect, and Criticality Analysis (FMECA) resources: http://www.jcaho.org/accredited+organizations/patient+safety/fmeca/fmeca.pdf Example with medication use: http://www.jcaho.org/accredited+organizations/patient+safety/fmeca/fmeca_chart.pdf How Providers Can Benefit From Using This Resource These resources have been compiled and presented as suggested materials providers and their staff can review and evaluate for their organizations. 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. These materials are offered for provider consideration with the understanding that each and every example/sample of a document and tool must be carefully evaluated by your organization. Each organization remains responsible for implementing policies and procedures that are in compliance with all existing state and federal laws and regulations governing long term care services in nursing homes. Suggested ways organizations may evaluate and consider using these materials: Formatting: Organizations may use these samples as suggested ways to improve the look and format of their own existing documents. Resources: The sample documents name staff roles and procedures that can represent different approaches and resources to use in care giving activities, different than your organization has considered previously. Resident Population/ Facility Culture: These samples were collected from facilities in every region of New York State. Each facility represents its own unique culture and serves a diverse resident population. Organizations must evaluate these samples with a sensitivity to those unique qualities and mindful of its own resident population and culture. Numbering of Documents: For ease of following this manual, we have numbered all pages in the bottom center of each page. Pages that are designed as sample documents have an additional numbering system on the top of the respective pages reflecting all pages included in that sample. Risk Assessment: Elopement All skilled nursing facilities are required to conduct comprehensive resident assessments at specific intervals during the residents stay. 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. This is the mechanism to assist the resident in attaining their highest practicable level of physical, mental, and psychosocial well being. Each facility may have their own process for assessing residents at risk for wandering or elopement. A variety of tools may be used to identify a resident at risk for wandering or elopement; however, the task force recommends that whatever tool is used, the following questions should be asked: Is the resident independently mobile? Is the resident cognitively intact? Does the resident have competent decision making capability? Does the resident wander? Does the resident have exit seeking behavior? Is there a past history of wandering or exiting a home or facility without the needed supervision? Does the resident accept their current residency in the facility? Does the resident verbalize a desire to leave? Has the resident asked questions about the facilitys rules about leaving the facility? Is there a special event/anniversary coming due that the resident normally would go to? Is the resident exhibiting restlessness and/or agitation? Answering yes to any one of these questions or a combination of them can identify the resident at risk for wandering and potential elopement. These questions can be integrated into the overall assessment, as some of them are already asked in the Minimum Data Set. 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. The interdisciplinary team should be responsible for identifying when additional assessments are needed. Note: The first few weeks of admission, a change in diagnosis/condition, or a special event seem to be the higher risk time frames for elopement. RISK ASSESSMENT ELOPEMENT DECISION TREE Resident Name:__________________ Unit: _________ Date:__________ N Signature: ______________________________ Date: ____________ Page 1 of 3 Wandering Risk Scale Policy#: Patient Care 3BDate: February 13, 2002 Revision: 6 (Last revised September 14, 1999) STANDARD A safe environment is provided for patients/residents who are at risk to wander. POLICY As part of admission assessment, all newly admitted Patents/Residents clinical status will be assessed by a registered nurse to determine their risk for wandering using the Wandering Risk Scale form. reassessed as follows: after 72 hours of admission every month for Patients/Residents identified as high risk to wander whenever there is a change in Patients/Resident/s clinical status Patients/Residents who are identified at risk to wander and high risk to wander must have an individualized plan of care PURPOSE To establish uniform guidelines in identifying and providing safety to all Patients/Residents at risk to wander. SCOPE All Patients/Residents RESPONSIBILITY Professional Registered Nurses PROCEDURES Wandering Risk Scale Direction of Use: Enter Patients/Residents name and diagnosis in the space provided. For Patients/Residents who are comatose, and/or dependent in ADL (who cannot move without assistance), this form does not need to be completed. However, check the appropriate box found at the left upper corner of the form to justify reason for not completing this form. Page 2 of 3 Enter the dates of assessment and reassessment in the appropriate boxes. 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 Patients/Residents condition. Add the scores and enter the number under the total score which will determine the risk for wandering. Scores of: 0 8 Low Risk 9 10 At Risk to Wander 11 above High Risk to Wander Action Required based on Wandering Risk Scale Score: If the Patient/Resident is identified as Low Risk to Wander, no nursing action to prevent wandering is needed. If the Patient/Resident is identified as At Risk to Wander. Initiate interdisciplinary care plan accordingly and follow plan of care. If the Patient/Resident is identified as High Risk to Wander, the following action must be taken: Initiate interdisciplinary care plan If the physicians order is to keep the patient/resident within the hospital, apply yellow armband and if the order is to keep the patient/resident within the unit, apply the red armband for immediate identification Refer to Hospital Police for photograph. Keep one copy of the patients/residents photograph in the medical record Refer to physician in charge for additional appropriate intervention such as the use of Dynaflow device If the Dynaflow device is used, follow the guidelines for use of the Dynaflow System, Administrative Policy Safety #7. If Dynaflow is not used, check the patients/residents whereabouts/activities in the unit every hour and more frequently as per assessed needs of the patient/resident. 4. If the Patient/Resident is missing, follow Hospital Policy on Patients Reported Missing Policy RI 20 and Nursing Policy on Missing Patients/Residents Patient Care 47. Page 3 of 3 Wandering Risk Scale Not Applicable: ( Comatose ( Patient dependent in ADL who cannot move without assistance ( Stuporous ADMITTING DIAGNOSIS: Medical Chart Number: Date of Assessment: (MENTAL STATUS can follow instructions 3 cannot follow instructions MOBILITY can move without assistance while in wheelchair 3 ambulatorySPEECH PATTERNS can communicate 3 cannot communicateHISTORY OF WANDERING no history of wandering 2 with history of wandering (past hospitalization or history from patient/family)Complete this item 72 hours after admission and as per instruction does not wander wanders with intentional destination/knows how to return to unit wanders within the hospital without leaving hospital grounds 5 wanders aimlessly within hospital or off hospital groundsComplete this item one month after admission and as per instruction no episode of wandering no episode of wandering for the past 6 months no episode of wandering of the past 3 months with episode for the past monthNo diagnosis of dementia 5 Medically diagnosed with dementiaTOTAL SCORE (NURSES INITIAL (Page 1 of 5 Missing Resident/Elopement Policy/Procedure Statement Originating Department: Administration Related Department: All POLICY It is the policy of to provide a safe and secure environment for all residents. 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. 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. Off hours all nursing personnel and security are to report to the Nursing office except for one CNA from each unit and one nurse from each floor and any other available staff, i.e., Housekeeping, Maintenance, and Dietary. 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. Notify security by radio. Response TeamUpon hearing Code 100 announcement, report to designated office Highest Ranking Onsite Staff MemberAssigns a search sector to each team member and records on the attached Elopement Incident Search Assignment form. Notifies DON/Administrator if needed and provides photo of resident to security, if needed. Staff Assigned to SectorWhen sector search completed report back to command post, i.e., Administrative office during regular business hours or Nursing office during off hours. Highest Ranking Onsite Staff MemberWhen resident is found, announce Code 100 cancelled and repeat three (3) times over PA system and radio and place call to . Administrator/DesigneeNotifies Police Department emergency #337-7777 that a resident is missing. Nurse in ChargeCompletes appropriate documentation including condition of resident when last seen. Administrator/Director of Nursing/Designee Notifies D.O.H. as per requirements Page 3 of 5 Elopement Incident Search Assignment Highest Ranking on-site staff member coordinating search: Sectors on PremisesStaff AssignedPost-Search Report & TimeOutdoor areasLower level North South Second Floor Third Floor Staircases between floors Lobby/Auditorium/Main Dining Room/Staff Dining RoomElevators Roof including staircases leading to roof Kitchen COMMENTS Page 4 of 5 Missing Resident Policy Audit Staff ResponsesYESNON/ADid CNA staff notify NM immediately after resident was discovered missing? Within first 15 minutes? Did NM notify security gate immediately with name, neighborhood and physical description of resident? Did NM assign staff to conduct room-to-room search on floor, public area and offices? Public area on floor All offices on floor Stairwells 4. Did NM post message on hotline information dial line at ext. ? Did NM enter password? Name of resident Neighborhood of resident Resident physical description Type and color of clothing 5. Did NM call switchboard operator to announce Code 100? 6. Did NM give switchboard operator: Name of resident Physical description of resident Did switchboard operator announce code 100 over public address system? Did each NM conduct a head-to-head search in their neighborhood to make sure that missing resident is not in their neighborhood? Did each NM call command post with results of the head-to-head search? Did Department Heads/NMs call the hotline information line ext. for additional information? Was a command post set up after code 100 was announced in the nursing office? Page 5 of 5 Staff ResponsesYESNON/ADid Department Heads/Designee report to command post after announcement of code 100? Was the most recent photo of resident brought to the command post? Were search assignment sheets distributed to staff? 15. Was the family contacted by SW to inform them of situation, gain further information as to family activities that might explain residents location? Did the command post notify administrator, nursing administration and director of social services? Did Administrator consult with command post regarding decision for notification of police department 911/or implementation of pyramid alert? Did Director of Security notify the police department if authorized by administration? 19. Did command post move to switchboard after 24 hours? Did administration decide which staff would return to regular duty? Did all staff remain on heightened alert? Was family notified of latest update? Did security director maintain liaison with police department until resolution of search? Did NM/SW notify the family? Did NM/SW ask security supervisor to notify police, if found by other than police? Did NM/SW disband command post? Did switchboard operator announce all clear for code 100? Did command post clear the message from the hotline or update message to say all clear for code 100 resident found? Did NM/charge nurse arrange for resident to be examined by MD? Did NM/charge nurse update CCP to attempt to prevent further occurrences? Did NM inform/consult with family regarding modifications in CCP? Was a post conference held within 72 hours after the resident was reported missing to review incident? 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. Do responses to any of these questions indicate risk for elopement? Determine if the wandering behavior endangers or distresses the resident. Review the intensity, duration, and frequency of wandering behavior over the past 7 to 14 days Is there a pattern to the wandering behavior (time of day/ nature of the environment/what was the resident doing) Identify stability/change in the nature of the wandering behavior How did the wandering behavior develop over time/were problems evident prior to admission or earlier in the residents stay Has the resident experienced recent changes (new unit/roommate, new caregiver, change in medications etc.) How does wandering behavior impinge on other functioning Does this endanger the resident and/or others and how? Are wandering behaviors related to daily variations in functional performances and how? Does wandering behavior problem lead to resistance to care? Does wandering behavior lead to difficulties dealing with people and coping in the facility? Review of potential causes of wandering behavior Cognitive status problems interactions Rule out delirium Consider impact of dementia diagnosis and review Cognitive Loss/Dementia RAP Presence of Mood and/or Relationship Problem Interactions Is there unresolved mood state or relationship problems- review Mood State and Psychosocial Well-Being RAPs Can a cause and effect relationship be determined? Does the presence or absence of other persons precipitate the wandering? Did a recent loss of loved one, change in staff etc. lead to the wandering? Has an activity or anniversary of an event led to the wandering? Environmental conditions Is staff sufficiently responsive and do they recognize early warning signs? Does staff follow the residents familiar routines? Does noise, crowding or dimly lit areas affect resident wandering, i.e., change of shift? Page 2 of 2 Illness/conditions Consider physical health factors such as pain Is there an acute illness, i.e., UTI affecting cognition)? Is a chronic condition worsening (Alzheimers or other dementias)? Is there impaired hearing, vision, ability to communicate or understand others? Current Treatment/Management Procedures: Positive and Negative Consequences Has the resident been evaluated by psych? What treatment if any has been effective? Is the onset of wandering behavior associated with start of a medication? Is the wandering behavior associated with the use of a physical restraint? Has the resident received care in a specially designed therapeutic unit? Are there special staff training programs to focus on managing the wandering behaviors? What disciplines are involved? How frequent/consistent is the training? Protocol of Care Wandering Resident Management Elopement Prevention All residents will be assessed for risk of elopement upon admission, quarterly, with significant change in condition MDS assessments and when behaviors indicate. 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. Facility uses multi-faceted approaches to assure resident safety: Environmental such as but not limited to: Alarmed doors Alarmed bracelets Color-coded bracelets Camera surveillance Security guard Signage Elopement prevention drills Missing person drills, etc. Communication such as but not limited to: Resident photographs at reception desk/exits Written notification to appropriate departments regarding at-risk residents etc. Staff education regarding responsibility to identify, report, and intervene related to wandering/elopement risk such as but not limited to: Anticipate resident needs based upon wandering triggers and patterns Acknowledge residents behavior as an attempt to communicate needs Encourage verbalization, identify etiology and recognize feelings etc. All residents will have a mechanism for being identified, i.e., name bands and compliance will be monitored. Support and identify need for wandering, and develop individualized activity plan in response, which is detailed in the residents care plan, i.e., ambulation program, movement, exercise, and dance. Care Plan Example #1 Resident Concern/ Issue /NeedResidents GoalStaff ApproachesDisciplineWanderer/Elopement: Evidenced by: Verbalizes intent to leave building/facility Wanders Leaves unit Verbalizes intent of going home Other Related to: Roommate problems Unstable medical condition (specify ) Pain Poor interpersonal relationships Frustration Memory impairment Impaired cognition Poor judgment Panic state New admission/change in environment History of elopement prior to admission Personal loss/bad news Resident strengths and preferences A need to walk, even at nighttime One of most favorite things to do was to take long walks in the woods with family Strong and steady on feet Strong family involvementResident will continue to walk in environment Resident will accept walking assistance from staff when he is tired or needs direction Resident will remain safe within the facilityDetermine residents walking pattern (day, night, etc.) Identify triggers indicating residents 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 participation in walking club Offer resident out of house nature trips, apple picking, leaf looking, etc. 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. PT Tues. OT Wed. SS Thurs. Act Fri. Nsg Activities Activities, SS SS, Nsg Dietary Nursing, SS, Activities Team Nursing Care Plan Example #2 Resident Centered Approach Resident Concern/ Issue /NeedResidents GoalStaff ApproachesDisciplineI am often confused and do not know where I am. I have a need to walk, even at nighttime. I need you to help me, keep me safe, and allow me to do all I can do for myself. One of my most favorite things to do was to take long walks in the woods with my wife and children. I am still strong and steady on my feet. I prefer to take the chance of falling while walking, knowing that I may be injured than to be limited from doing what I enjoy.I will continue to walk in my environment. I will accept you walking with me when I am tired or need your direction. I will remain safe within the facility.Determine residents walking pattern (day, night, etc.) Identify triggers indicating residents 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. 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. PT Tues. OT Wed. SS Thurs. Act Fri. Nsg Activities Activities, SS SS, Nsg Dietary Nursing, SS, Activities Team Nursing Examples of Care Plan Interventions This is a recommended list of interventions to prevent elopement, but is by no means all inclusive: Avoiding events that lead to wandering behavior, i.e., crowded events, loud noises Reviewing medications that may cause anxiety, impaired visions, or poor balance such as sedative drugs, with ongoing assessment of their effectiveness Decorating their room with favorite pictures, books, etc. to provide a sense of comfort and familiarity Permitting the residents to look outside a window to keep track of the seasons of the year Having residents who wander wear a designated item of clothing for ease of identification Camouflaging doors with wallpaper or curtains so they are not recognized as doors*** Monitor response/reaction to events/activity in surroundings at time of wandering Anticipate needs based upon wandering triggers and patterns Acknowledge residents behaviors as an attempt to communicate needs Encourage verbalization, identify etiology and recognize feelings Support and identify need for wandering, and develop individualized activity plan in response, i.e., ambulation program, movement program, exercise and dance Determine residents walking pattern (day, night, etc.) Identify triggers indicating residents 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 participation in walking club Offer resident out of house nature trips, apple picking, leaf looking, etc. 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 Encourage resident to participate in the above activities Apply wander guard bracelet on residents wrist or ankle Provide activity at change of shift to keep resident busy at time of high noise and exiting of staff Utilize alarmed doors at time of meals to prevent wandering off units Identify activities for the residents based on their past work life/habits/hobbies Communicate residents potential for wandering to staff at the unit and exit areas Assess residents psychological or psychiatric status Utilize volunteers to visit with residents *** Check the CMS guidelines to ensure proper coverings allowed by code. Quality Improvement Guidelines/suggestions A goal of resident safety and risk management should be inherent in each Skilled Nursing Facilitys Quality Improvement (QI) program. The following ideas are recommended to be reviewed/ incorporated into the safety/risk management aspect of a skilled nursing facilitys QI process: Establish a proactive/preventive method of Quality Improvement Establishment of specific, practical and effective policies and procedures will assist in developing the monitoring aspect of this program Monitor the effectiveness of the elopement/wandering program by: Sampling assessments, care plans and outcomes concurrently to identify if the facility policy and procedures are being followed and establish compliance. Conduct drills periodically to evaluate the effectiveness of the Missing Residents Procedure and staff knowledge level of procedures. Monitor compliance to providing education as described in facility policy. Evaluate the learning objectives of the orientation program and any other education of staff related to this topic. This can be done by monitoring a few key questions related to the materials after each class and at intervals ongoing in practice settings. Monitor the effectiveness of the environmental methods used to prevent elopement on a periodic basis. Review each incident of elopement or near miss elopements individually but also collectively to identify any resident/facility trends. 4. Utilize the facilitys policies, procedures and standards to assist in evaluating the effectiveness of these facility standards and to keep the process simplified. Page 1 of 4 JCAHO FRAMEWORK FOR CONDUCTING A ROOT CAUSE ANALYSIS Level of AnalysisQuestionsFindingsRoot CauseAsk WhyTake ActionWhat happened?Sentinel EventWhat are the details of the event? (Brief description)When did the event occur? (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? (a flow diagram may be helpful here).What steps were involved in (contributed to) the event?Human factorsWhat human factors were relevant to the outcome?Equipment factorsHow did the equipment performance affect the outcome?Controllable environmental factorsWhat factors directly affected the outcome?Uncontrollable external factorsAre they truly beyond the organizations control?OtherAre there any other factors that have directly influenced this outcome?What other areas or services are impacted? Page 2 of 4 JCAHO FRAMEWORK FOR CONDUCTING A ROOT CAUSE ANALYSIS Level of AnalysisQuestionsFindingsRoot CauseAsk WhyTake ActionWhy did that happen? What systems and processes underlie those proximate factors? (Common cause variation here may lead to special cause variation in dependent processes) Human Resources IssuesTo what degree is staff properly qualified and currently competent for their responsibilities?How did actual staffing compare with ideal levels?What are the plans for dealing with contingencies that would tend to reduce effective staffing levels?To what degree is staff performance in the operant process(es) addressed?How can orientation and in-service training be improved?Information Management IssuesTo what degree is all necessary information communicatedTo what degree is communication among participants adequate?Environmental Management IssuesTo what degree was the physical environment appropriate for the processes being carried out?What systems are in place to identify environmental risks?What emergency and failure-mode responses have been planned & tested? Page 3 of 4 JCAHO FRAMEWORK FOR CONDUCTING A ROOT CAUSE ANALYSIS Level of AnalysisQuestionsFindingsRoot CauseAsk WhyTake ActionWhy did that happen? What systems and processes underlie those proximate factors? (Common cause variation here may lead to special cause variation in dependent processes) Leadership IssuesTo what degree is the culture conductive to risk identification and reduction? Encouragement of communicationWhat are the barriers to communication of potential risk factors? Clear communication of prioritiesTo what degree is the prevention of adverse outcomes communicated as a high priority? How?Uncontrollable factorWhat can be done to protect against the effects of these uncontrollable factors? Page 4 of 4 JCAHO FRAMEWORK FOR CONDUCTING A ROOT CAUSE ANALYSIS FindingsRisk Reduction StrategiesMeasurers of EffectivenessFor each of the findings identified in the analysis as needing action, indicate the planned action, expected implementation, date, and associated measure of effectiveness, or If after consideration of such a finding, a decision is made not to implement an associated risk reduction strategy, indicate the rationale for not taking action at this time. Check to be sure that the selected measure will provide data that will permit assessment of the effectiveness of the action. Consider whether a pilot test of the planned improvement should be conducted. Improvements to reduce risk should ultimately be implemented in all areas where applicable, not just where the event occurred. Identify where the improvements will be implemented.Action Item #1 MeasureAction Item #2 MeasureAction Item #3MeasureAction Item #4MeasureAction Item #5MeasureAction Item #6MeasureAction Item #7MeasureAction Item #8Measure Cite any books or journal articles that were considered in developing this analysis and action plan: General Principles for Wandering/Elopement policies and Procedures The Task Force recognizes that there are a number of factors/principles that can be applied to any and all elopement-related facility policies. While not required by regulations, the following principles will nonetheless likely assist nursing facilities in developing and reviewing their policies and procedures. 1. Policies should reflect an interdisciplinary approach, with the team being involved in the initial and ongoing risk assessments, care planning, and resident/family/staff education. 2. For taking photographs of residents at risk for wandering, it is advisable for it to be clearly spelled out who takes the pictures and when, and the process by which photographs are updated and maintained. 3. For elopement risk assessment tools/forms, it is appropriate and useful for the relevant MDS items to be referenced. 4. Policies should address how all staff will know if a resident is appropriate to be off a unit or outdoors unsupervised, and what actions to take if he/she is in a potentially unsafe situation. 5. It is helpful if there are criteria specified in the resident's plan of care for when interventions are to be implemented. 6. It is also helpful if there are criteria for how often, where, and when missing resident drills are conducted, as well as a defined system for determining frequency and type/location of drills. These factors may be based on criteria the facility establishes, which can include elements such as time of year, the resident population/residents at risk, the outcomes of drills, etc. The facility Quality Assurance committee is an appropriate body to drive these determinations. 7. If alarms are ever disengaged (such as for repair), facilities should consider what backup systems exist to safeguard residents in the interim. For example, if an exit alarm is disengaged for a delivery, the area should be cordoned off during that period of time. 8. Facilities should consider what the process is for determining which residents have a personal alarm in place, who will do the daily maintenance checks, and where are those checks documented, etc. 9 Facilities should consider when a resident is determined "missing." This is very important and needs to be spelled out in facility policies. Time is not necessarily the determining factor. 10. Facilities should consider conducting an immediate root cause analysis when an elopement occurs. 11. Policies should indicate when an elopement is reported to the Department of Health and other authorities. Page 1 of 2 Frequently Asked Questions Related to Resident Elopement Question 1: When is a resident considered to have eloped? When he/she leaves the unit or exits out the main entrance? How is elopement defined? Answer: Elopement is defined as the ability of a resident to successfully leave the nursing facility unsupervised and unnoticed and enter into harm's way. 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. Because each event will involve a multitude of factors/variables, arbitrary criteria cannot be applied in defining what is a citable situation. One factor to consider is whether system issues have contributed to the elopement. For example, were there appropriate systems/safeguards in place? Did staff follow the established protocols and systems? Question 2: If a cognitively impaired resident leaves the building, but is seen leaving and immediately returned, does this situation need to be reported to DOH as an 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. 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. If, for example, the resident was not assessed for wandering/elopement risk and the facility did not have a process to determine residents at risk for elopement, this could be a citable situation. Question 3: A short-term resident leaves on a day pass to visit with his brother, but doesnt return by the end of the day. The facility locates the resident in the evening, and he returns safely with his brother. Does this event need to be called into the Health Department? Answer: Resident rights will dictate in this situation. 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. Question 4: A short-term resident decides she wants to return home rather than complete her course of in-house therapy. The facility explains any risks to the resident, and offers alternatives, but the resident insists on returning home. Does this have to be called into the DOH? Page 2 of 2 Answer: No. The resident is leaving the facility Against Medical Advice (AMA) or self-discharging. The facility will want to inform the local Adult Protective Service of the discharge but this would not be considered an elopement situation. Question 5: A resident is missing for three hours and the local police have been notified. When should the facility contact the DOH? Answer: Immediately. The residents whereabouts are unknown. Whether the resident is alert and oriented or confused, facility staff should let the DOH know that the resident is missing. Question 6: Does an elopement/wandering risk assessment have to be conducted for all residents? Answer: Yes. Standard procedure in the facility should be to evaluate all residents for the risk of elopement or wandering. Question 7: Does the facility need to conduct a root cause analysis every time a resident attempts to elope from the facility? 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. Question 8: How often do missing resident drills need to be conducted? Answer: It is recommended that the drills be conducted no less than annually. Question 9: What departments other than nursing have a role/responsibility with respect to elopement prevention? Answer: All departments should have a role in preventing resident elopement. Whether that role is assessment or general observations of behavior, each department needs to be aware of the potential for residents to exit the facility and place themselves in danger. Tab Alarms, Bed Alarms, Wanderguard System POLICY Tab alarms or bed alarms may be used on a resident who is deemed unsafe through the nursing assessment and documented on the residents care plan that the resident is at risk for falls. The Wanderguard would be used for residents at risk for elopement. PURPOSE For each resident to reach his/her highest practicable well being in an environment that prohibits the use of restraints for discipline or convenience. PROCEDURE 1. Nursing Assessment of each resident must be done on admission and change in status to evaluate if he/she is at risk for falls or elopement. A plan of care must be formulated with the Interdisciplinary Team (Nursing, Physical Therapy, Occupational Therapy, Dietary, Activities, Social Worker, and Resident/Family), to determine the need for tab or bed alarms or Wanderguard bracelet and documented in the Care Plan. The tab alarm will be utilized on the resident when they are out of bed in a wheelchair or chair. The bed alarm will be utilized on the resident while they are in bed. The Wanderguard bracelet will be applied to the residents wrist or ankle and not removed until replacement is needed. After applying the tab alarm or bed alarms in place, a safety check to make sure they are in proper working condition must be done before leaving the resident. Documentation of the tab and bed alarm checks will be made in the treatment books on each unit each shift daily. Before application of tab or bed alarms, they are dated on the date of application and documented in the alarm logbook located in the ADON Office. The first Monday of each month, a LPN will be assigned to replace all bed and tab alarms on all the units and document in the log book. The Wanderguard bracelets are checked daily on the night shifts by the Supervisor and are documented in the treatment book on the units and the Wanderguard Folder in Peach Treatment Room. Unplanned Discharge Policy/Procedure Statement Department: Administration/Social Work/ Residential Services/NursingNo:Page 1 of 1Subject: Unplanned Discharge (AMA/ACA/AWOL) POLICY will advise residents of the risks of early, unplanned discharge, and provide appropriate referrals & discharge instructions whenever possible. PURPOSE To provide the safest discharge possible for residents leaving the facility against advice. PROCEDURE Discharge Against Medical Advice (AMA) The MD, NP, or Nurse will: Advise resident of the risks to their health & well-being if they choose to leave with an unstable medical condition Obtain and witness residents signature on AMA form Provide referrals for medical, psychiatric or other services as needed The Nurse will: Notify the Medical Provider on-call of any resident wishing to leave AMA/ACA Provide residents with discharge instructions & review medications Discharge Against Clinical Advice (ACA) The Social Worker or Substance Abuse Counselor will: Advise the resident of the risk of relapse if the resident chooses to leave before completing the Substance Abuse Treatment Program Obtain & Witness residents signature on AMA/ACA form Provide referrals to community services as needed Notify the Nurse-In-Charge of residents wishing to sign out AMA/ACA Discharge AWOL (Absent Without Official Leave) Residents not returning from pass or outside appointments as scheduled will be considered AWOL Residents who leave the facility without permission & without signing AMA/ACA will be considered AWOL The Social Worker will: Notify the Administrator of resident being AWOL Notify residents legal mandate, if applicable Notify residents family, if applicable Arrange a meeting with all appropriate parties to discuss discharge Drill to Locate Missing Resident Probe Alert Code ORANGE Policy/Procedures Statement Issued by: Administration Policy #: A 121 Effective Date: Last Review Date:Supersedes: NONE Approved by: Department Head Date Administrator Date POLICY In order to comply with regulatory agencies, conduct announced or unannounced drill to locate missing resident. The drill will also suffice the regulation for emergency preparedness (483.75 m). GOAL The primary goal is to maintain resident safety for all residents at high risk of elopement from the facility. PROCEDURE Drills will be conducted either announced or unannounced to test the effectiveness of the Policies and Procedures affecting residents at high risk for elopement and to test the effectiveness in locating missing residents. The Policy and Procedure or collection of policies and procedures are not limited to the following: Nursing Department P & P #1.37 .(Wandering Residents) Administrative P & P #2 043 (Missing Residents) Administrative P & P #A 116 (Wandering Residents Administrative P & P #A 119 (Emergency Communication Matrix) Administrative P & P #A 115 (Building Search Protocol for Residents Care Planned as Wanderers) Memorandum Dated July 14, 2000 Additional Procedures to Protocols for Missing, Controlling and Monitoring of Resident Care Planned as Wanderer Drill to Locate Missing Resident Probe Alert Code ORANGE In addition to the above Policies and Procedures the Security Officer on duty upon receiving an instruction to activate Missing Resident Code will overhead page PROBE ALERT CODE ORANGE, followed by resident name three (3) times. Individual / DisciplineResponsibilityClinical Staff/CNA/CN/ Ancillary StaffMake a determination if resident is missing Report to the Charge Nurse that the resident is unaccounted forCharge NurseCall Lobby Security Officer on duty by dialing ext. 3919 and report Active Code Orange, in the unit where the resident resides and resident nameSecurity OfficerOverhead page Probe Alert Code Orange and Resident Name three (3) times Pull out and have the residents picture ready for reference Radio call to all officers on duty Probe Alert Code Orange, the unit and the resident name three (3) times Call Central Security office to report the eventAdministrator/Designee/ AOD/Administrative Nursing SupervisorConvene the committee for the planned drill Present plan to the committee for approval Establish a command center preferably in the unit where missing resident resides Take the leadership in the delineation of work or assignments Record progress of search and rescue procedures conductedCharge Nurse Other UnitsEstablish a mini Command Center in their units Take the leadership in the delineation of work or assignment in that particular unit in carrying out procedures to locate the missing resident Record progress of search and rescue procedure conductedSecurity Officer(s)Take the leadership in the delineation of work or assignment in the search and rescue procedure of the missing resident in the following areas: basement; stairwells; rooftop; 1st floor lobby Record progress of search and rescue procedures conductedCommander Officer (Administrator/Designee/AOD/ Administrative Nursing SupervisorTake the leadership to make the drill as realistic as possible Make known to all participants that all actions and decisions shall be known to the Command Officer, especially actions outside of Policies and Procedures or collection of Policies and Procedures to locate a missing resident Make a determination to continue as to the duration of the drill Call all participants to convene in an area to critique the drill Record criticisms of the drill Present criticism to QA Committee for Performance ImprovementPage 1 of 5 Missing Resident/Elopement Policy/Procedure Statement Originating Department: Administration Related Department: All POLICY It is the policy of to provide a safe and secure environment for all residents. 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. 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. Off hours all nursing personnel and security are to report to the Nursing office except for one CNA from each unit and one nurse from each floor and any other available staff, i.e., Housekeeping, Maintenance, and Dietary. 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. Notify security by radio. Response TeamUpon hearing Code 100 announcement, report to designated office Highest Ranking Onsite Staff MemberAssigns a search sector to each team member and records on the attached Elopement Incident Search Assignment from. Notifies DON/Administrator if needed and provides photo of resident to security, if needed. Staff Assigned to SectorWhen sector search completed report back to command post, i.e., Administrative office during regular business hours or Nursing office during off hours. Highest Ranking Onsite Staff MemberWhen resident is found, announce Code 100 cancelled and repeat three (3) times over PA system and radio and place call to . Administrator/DesigneeNotifies Police Department emergency #337-7777 that a resident is missing. Nurse in ChargeCompletes appropriate documentation including condition of resident when last seen. Administrator/Director of Nursing/Designee Notifies D.O.H. as per requirements Page 3 of 5 Elopement Incident Search Assignment Highest Ranking on-site staff member coordinating search: Sectors on PremisesStaff AssignedPost-Search Report & TimeOutdoor areasLower level North South Second Floor Third Floor Staircases between floors Lobby/Auditorium/Main Dining Room/Staff Dining RoomElevators Roof including staircases leading to roof Kitchen COMMENTS Page 4 of 5 Missing Resident Policy Audit Staff ResponsesYESNON/A1. Did CNA staff notify NM immediately after resident was discovered missing? Within first 15 minutes? Did NM notify security gate immediately with name, neighborhood and physical description of resident? Did NM assign staff to conduct room-to-room search on floor, public area and offices? Public area on floor All offices on floor Stairwells 4. Did NM post message on hotline information dial line at ext. ? Did NM enter password? Name of resident Neighborhood of resident Resident physical description Type and color of clothing 5. Did NM call switchboard operator to announce Code 100? Did NM give switchboard operator: Name of resident Physical description of resident Did switchboard operator announce code 100 over public address system? Did each NM conduct a head-to-head search in their neighborhood to make sure that missing resident is not in their neighborhood? Did each NM call command post with results of the head-to-head search? Did Department Heads/NMs call the hotline information line ext. for additional information? Was a command post set up after code 100 was announced in the nursing office? Page 5 of 5 Staff ResponsesYESNON/ADid Department Heads/Designee report to command post after announcement of code 100? Was the most recent photo of resident brought to the command post? Were search assignment sheets distributed to staff? 15. Was the family contacted by SW to inform them of situation, gain further information as to family activities that might explain residents location? 16. Did the command post notify administrator, nursing administration and director of social services? Did Administrator consult with command post regarding decision for notification of police department 911/or implementation of pyramid alert? Did Director of Security notify the police department if authorized by administration? 19. Did command post move to switchboard after 24 hours? 20. Did administration decide which staff would return to regular duty? Did all staff remain on heightened alert? 22. Was family notified of latest update? Did security director maintain liaison with police department until resolution of search? Did NM/SW notify the family? Did NM/SW ask security supervisor to notify police, if found by other than police? Did NM/SW disband command post? Did switchboard operator announce all clear for code 100? Did command post clear the message from the hotline or update message to say all clear for code 100 resident found? Did NM/charge nurse arrange for resident to be examined by MD? Did NM/charge nurse update CCP to attempt to prevent further occurrences? Did NM inform/consult with family regarding modifications in CCP? Was a post conference held within 72 hours after the resident was reported missing to review incident? Page 1 of 6 Patient/Resident Leave of Absence and Pass Policy Policy #:Date:Revisions: POLICY The facility recognizes the rights of rResidents, for whom ________ is their home, to leave the campus for limited periods for therapeutic reasons. The facility also recognizes the need of rRehabilitation pPatients for therapeutic leave in preparation for discharge. It is not in the best interest of hHospital pPatients toatients to leave the campus, but they are encouraged to enjoy the hospital grounds between times of the provision of medical care. Because the purpose of admission is to provide a continuum of care and treatment, leaves of absence and passes may be granted in accordance with specific guidelines. PURPOSE To clarify circumstances under which authorization for leaving the facility is needed. To establish guidelines regarding the right to return to the residential environment upon termination of an authorized leave of absence or pass. SCOPE This policy applies to the hospital and nursing facility. 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. It also applies to rehabilitation patients who seek leave in preparation for imminent discharge and advises hospital patients of their entitlement to campus passes only and of their lack of eligibility for authorized absences or day passes. 1. Therapeutic Leave of Absence - Nursing Facility - (for nursing facility residents only) Overnight absence for therapeutic purposes. Not applicable for temporary absence due to admission to other health care facilities. 2. Therapeutic Leave of Absence - Rehabilitation - (For rehabilitation patients only) Therapeutic leave beyond the normal census-taking hour, which does not exceed two days. 3. Day Pass - (For nursing facility residents only) - Authorization to leave the campus until 9:00 p.m. of the day the pass is issued for therapeutic reasons. 4. Campus Pass - (For hospital and rehabilitation patients) - Authorization to leave the building for periods of time while no medical care is being provided but to remain within the perimeter of the campus, unless traveling to the other campus by facility transport. (For purposes of this policy, the campus is defined as the geographical area, which encompasses the front of the facility buildings and the grounds on which they are situated.) Page 2 of 6 5. Days of Absence - Accounting of days chargeable against a calendar year balance; computation will include day of departure, but not day of return. RESPONSIBILITY It is the responsibility of the physicians, nurses and the hospital police department to ensure adherence to this policy. It is the responsibility of the finance department to track the overnight leave time utilized. It is the responsibility of the resident/family/responsible party to participate in leaves of absences and facility passes in a manner that does not jeopardize or threaten the resident's/patient's goals of treatment and care. PROCEDURE LEAVE OF ABSENSES Criteria Patients or residents who leave the facility outside of the parameters of this policy are subject to loss of insurance coverage for the period of their absences and personal responsibility for costs incurred in readmission or holding their bed. 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. The resident has resided in the nursing facility for a period of 30 consecutive days or more, prior to this leave. This residency requirement does allow for interruption due to hospitalization. 2. The resident has not been granted leave for more than 18 days during the current calendar year. 3. The leave is for therapeutic purposes. Rehabilitation: Rehabilitation patients may be granted leave in preparation for discharge as follows: 1. The leave is for therapeutic reasons and imminently leading to discharge and must be both documented in the medical record and in the physicians treatment plan. 2. The leave is up to two days at a time. Medicine: 1. It is not in the best interest of hospital patients to leave the campus, but they are encouraged to enjoy the hospital grounds in between times of the provision of medical care. Page 3 of 6 B. Process: Nursing Facility: 1. A resident requesting a leave of absence from the nursing facility shall complete a Resident Leave Request (see attached*). Requests for leave of absence by the resident will be submitted a minimum of forty-eight (48) hours in advance. 2. This form shall be submitted to medicine and nursing. 3. The physician or registered physician assistant (RPA) will complete and sign the Leave and Pass Authorization based on clinical evaluation and discussion with the resident. The nursing unit shall issue to the patient a pass (see attached*). Nursing shall ensure that the resident has his/her identification bracelet attached prior to issuance. 4. The nursing unit shall enter on the pass and in the medical record the date and time the resident leaves the facility. 5. The nursing unit shall also complete the portion of the pass indicating the total number of leave days used during the 12-month period. Residents in the nursing facility are eligible for an authorized leave of absence for up to eighteen (18) days per twelve (12) month period. Any request for leave in excess of the 18-day policy limit or any request for leave exceeding 14 consecutive days must be referred to administration for approval. The resident is eligible for an authorized leave of absence after thirty (30) consecutive days following the current admission. 6. Upon the residents return, hospital police will: (a) Record the actual date and time of patients return to the facility in the security log. (b) Mark through the pass card with an ink pen to ensure that the card cannot be altered and used again. 7. The nursing unit shall reflect the time of return to the unit in the medical record. 8. Should a resident in the nursing facility request an extension beyond the 18-day limitation, the patient shall be referred to his social worker who will request an extension. This request for an extension must be submitted to the finance office at least one week prior to the proposed leave date. 9. Should a resident not return on the requested date of pass, the nursing unit should notify the finance office. Rehabilitation Service Patients: A Rehabilitation patient may request authorization for overnight leave under the following conditions: 1. A patient requesting a leave of absence shall be preparing for imminent discharge and shall complete the Patient/Resident Leave Request. 2. This form will be submitted to medicine and nursing. 3. The physician will assess whether the patient is medically stable and whether the leave has a therapeutic purpose. If so, authorization for the leave in excess of regular census hours, along with the therapeutic reason for the leave, shall be noted in the physicians order section of the medical record. (The reason for non-issuance of a pass shall be documented in the progress notes.) The head/charge nurse shall issue the patient a pass. Nursing shall ensure that the patient has his/her identification bracelet attached prior to issuing a pass. * Documents are not attached, but denote need for respective forms. Page 4 of 6 4. The nursing unit shall enter on the pass and in the medical record the date and time the patient leaves the hospital. 5. The nursing unit shall also complete the portion of the pass indicating the total number of leave days used during the calendar year. 6. The nursing unit shall reflect the return time in the medical record. Patients deemed safe for a leave, escorted by a family member, next of kin, or responsible party, will be identified by a yellow wristband. Accompanying family/person will sign the pass and assume responsibility for the patients safety. Patients not adhering to this policy will be provided with a copy of a notification letter, receipt of which will be noted in the medical record. Further passes will be determined with the participation of the interdisciplinary team. 2. DAY PASSES A. Nursing facility residents may obtain day passes. 1. For residents, day passes may be issued for one or more days (from 10:30 a.m. to 9:00 p.m., to be adjusted seasonally or for special circumstances) at the discretion of the physician/RPA who will assess whether the patient is medically stable and whether the request has a therapeutic purpose. If so, authorization shall be noted in the physicians order section of the medical record. In the event of a request for the authorization of a day pass for multiple days, in addition to the physician/RPA approval, the interdisciplinary team shall review the request to determine its appropriateness consistent with the care plan. Requests for authorization for multiple-day passes shall be reviewed once a month by the team to evaluate any change in condition. If approved, a separate pass will be issued each day, weather permitting, by nursing to enable the nursing staff to assess the resident and observe any change in the residents condition. Nursing shall ensure that the resident has his/her identification bracelet attached prior to issuance. 2. Eligible residents will request a day pass at least 24 hours in advance. Exception may be made by the ADON in conjunction with the unit physician, giving consideration to as to whether the residents medical condition, medication needs and related equipment needs can be safely met on shorter notice. The resident remains responsible for returning to the facility by 9:00 p.m. on the day of the pass. 3. Approved day passes must be documented in the resident's medical record. 4. The appropriate Day Pass Form must be completed and a copy maintained by nursing until the residents return. 5. Residents who overstay their day pass and/or leave hospital premises without following facility procedures, will be provided with a copy of a notification letter receipt of which will be noted in the medical record. Further passes will be determined with the participation of the interdisciplinary team. 6. Patients deemed safe for a leave, escorted by a family member, next of kin, or responsible party, will be identified by a yellow wristband. Accompanying family/person will sign the pass and assume responsibility for the patients safety. 7. The head/charge nurse will process the day pass and document in the medical record. The nurse will inform the assigned interdisciplinary team if the resident does not adhere to the pass policy, and document this in the medical record. Page 5 of 6 3. CAMPUS PASSES A. Eligibility: 1. For those patients who are assessed by the physician/RPA as medically stable, and who wear their hospital identification bracelets, campus passes may be issued for one or more days, weather permitting, for use between the hours of 10:30 a.m. to 9:00 p.m. (which will be seasonally adjusted) upon assessment by and at the discretion of the physician/RPA. This pass permits the patient to enjoy the area outside the buildings on hospital grounds, for periods when medical care is not scheduled, Patients who overstay their day pass and/or leave hospital premises without following facility procedures, will be provided with a copy of a notification letter, receipt of which will be noted in the medical record. Further passes will be determined with the participation of the interdisciplinary team. The patient remains responsible for returning to his/her unit by 9:00 p.m. on the day of the pass. Patients deemed safe for a leave, escorted by a family member, next of kin, or responsible party, will be identified by a yellow wristband. Accompanying family/person will sign the pass and assume responsibility for the patients safety. B. Procedure: 1. Patients will request the campus pass from nursing staff. 2. The first Campus Pass Form request by the patient shall be referred to the unit physician/RPA by the nursing staff who will assess and document in the progress notes whether the patients medical condition, medication needs, and equipment needs can safely permit issuance of the pass. Should the physician/RPA determine that a pass should be issued for one or more days, this order shall be noted in the physicians order section of the medical record. 3. Once this initial assessment is completed for the respective patient, additional assessments and changes in the physicians order will be required only when there has been a change in circumstance in the patients condition as noted by unit staff. 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 patients condition. 4. The head/charge nurse will process the campus pass and document the patients departure in the medical record accordingly. Verification that the patient is wearing a hospital identification bracelet is required before the pass is issued. 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. 5. The hours and days permitted for campus passes are subject to modification due to weather or at the discretion of hospital administration in the best interests of the patients. Page 6 of 6 4. GENERAL RESPONSIBILITIES FOR ALL PASSES 1. 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 also the responsibility of the patient/resident receiving the pass to adhere to this policy, to sign the pass acknowledging the conditions under which it is issued, and to present the pass to the hospital police officer upon exiting, which shall be done only through the main lobby. 2. It shall be the responsibility of the physician/RPA to approve passes for one or more days and to document same in the medical record. 3. It shall be the responsibility of the head/charge nurse to process authorization for a pass; to ensure documentation in the nurses notes section of the medical record for day and overnight passes; to confirm that patients/residents wear their ID bracelet before issuing the pass; and to call an interdisciplinary team meeting when a patient/resident does not adhere to the policy. 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. For multi-day passes, the nursing staff must assess the patients medical stability each day a pass is requested. 4. It shall be the responsibility of the hospital police to: a) check the pass and the identification of patients/residents when leaving the hospital building and to make the appropriate entries in the hospital police log book. b) retrieve passes when the patient/resident returns to the hospital building and note time of return. (The patient/resident can obtain an unexpired pass from hospital police if she/he desires to leave the hospital again.) c) bring to the attention of the Administrator on Duty or the Assistant Director of Nursing when the pass policy is not adhered to, so that appropriate action can be taken. d) to notify the Department of Nursing if a patient/resident attempts to or leaves the hospital without a pass. A. Patient/Resident Return: 1. The head/charge nurse shall: a) record the date and time of return in the daily report (except for campus passes) document in the medical record the return of the resident or rehabilitation patient from overnight pass or if the patient/resident fails to return from or does not adhere to the day/campus pass. 5. FAILURE TO RETURN If a patient/resident does not return from pass and/or fails to notify the Department of Nursing of an impending delay, the following shall occur: 1. Any hospital patient who fails to return to the facility by 12:01 a.m. of the day after leaving the facility without authorization will receive a notice upon his/her return documenting the event. Reviewed By: Date:__________________ Reviewed By: Date:__________________ Staff Training Sample Interventions for Residents Exhibiting Wandering Behavior In addition to staff training on the facilitys 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. General interventions may include: Validate the residents concerns. Re-direct the resident. Attempt to engage him/her in an activity such as: Folding laundry Wiping tables Rolling up balls of yarn Sweeping the floor Never leave resident who is attempting to leave the facility until he/she is in a safe area. Ask the resident where they are going and why are they leaving? The answers the resident gives to these questions will determine the appropriate response. Examples: I have to go meet my sons school bus. An appropriate response may be Mary, you still have 2 hours before the bus arrives why dont you come with me until then My daughter is picking me up soon. An appropriate response would be Mary, Im sorry, I forgot to tell you that your daughter called and she is having car trouble and wont be able to come today. Educate staff on the times of day that trigger exit seeking behavior after meals and at the afternoon change of shift. Educate staff on the various alarm systems utilized for wandering residents. Educate staff on the importance of visual checks of residents identified at risk for wandering. Role play with staff on resident elopement behaviors. Building Assessment Guidelines Unsafe Wandering & Elopement The layout, design, and security features of all portions of the facility are assessed to determine each component's potential impact on unsafe wandering and elopement. Include exterior spaces used or possibly accessible to residents. Due to the significant differences in staffing and operational practices that may occur in nursing homes over the course of the day and week, the assessment should be completed on both weekdays and weekends and for each shift. Reassessments should be done as structural and operational changes occur at the nursing home. Investigations of unsafe wandering and elopement must include an evaluation of contributing building features and systems. Necessary revisions to the building assessment tool and continuing revision of security and supervisory and operational procedures are expected to result from changes to the building and from incident investigations. The behaviors and underlying cause of each resident's wandering may differ. All measures developed to safeguard residents prone wandering or elopement must be individualized. The sample tool below represents one possible assessment scheme. The tool begins by identifying risks in the resident room, moves to areas on the unit, and continues progressively moving to areas at increasing distances from the resident room. Since most elopement risk factors are common to many areas of the building, specific probes appear the first time a risk factor is identified and are not repeated for each area of the building. Some unusual or high hazard features that may pose additional safety or elopement risk are included at the end as are some general pointers regarding security features and systems. Page 1 of 2 Sample Building Assessment Tool BUILDING STRUCTURAL FEATURES On Unit Spaces Resident Rooms Windows stops or security screens are present to prevent access to grade, adjoining roofs, accidental falls, or suicide attempts stops or security screens are secured in a manner that cannot be easily undone Doors is the door to the corridor in a location that is visible to staff from the nursing station and/or areas routinely traveled/occupied by staff during the course of their duties? does the room have a second door to the exterior, a porch or another corridor, if so, is the second door secured or in a location that is visible to staff from the nursing station and/or areas routinely traveled/occupied by staff during the course of their duties? does the room connect to an adjacent room via the toilet room or another door, if so is the door to the corridor from the adjacent room in a location that is visible to staff from the nursing station and/or areas routinely traveled/occupied by staff during the course of their duties? Communal Areas lounges, dining and activity rooms and areas Windows Doors Stairs is the door to the stair in a location that is visible to staff from the nursing station and/or areas routinely traveled/occupied by staff during the course of their duties? is the door to the stair alarmed? is the door to the stair locked? (if a required exit, only those locks complying with the Life Safety Code and other applicable Fire and Building Codes may be used, see DAL0307 Protected Environments. ( Elevators is the elevator visible to staff from the nursing station and/or areas routinely traveled/occupied by staff during the course of their duties? is use of the elevator restricted through the use of swipe cards, keypads, wander-guards or some other manner? Non-Resident Areas staff, storage, utility, mechanical spaces, etc is access to the area restricted/supervised? If not is egress from the areas is restricted/supervised Windows Doors Stairs Elevators Unit egress from the corridor spaces of the unit Windows Doors Stairs Elevators Page 2 of 2 Adjacent Units assess in the same manner as the residents home unit do not assume all units are the same Off Unit Areas Resident Use Areas Windows Doors Stairs Elevators Non-Resident Use Areas Windows Doors Stairs Elevators Access Paths to Off Unit Areas does the building design promote or hinder supervision of ways of travel; access to non-resident and other areas of concern both in and out of the building is restricted and/or supervised? Windows Doors Stairs Elevators other corridors Exterior Doors to the Exterior Supervision are doors located in an area that permits staff supervision? Locks do fire codes permit locking; is it practical to lock the door? Number of Exits is the door a required exit, if not, can the NH safely eliminate this designation and restrict egress by locking? Resident Use Areas patios, courtyards and other exterior areas are located/equipped to permit supervision; use is limited to those assessed as not at risk for unsafe wandering and/or the area is fenced in. Non-Resident Use Areas resident access is restricted; access points and routes are restricted/supervised. Main Entrances Roofs Loading Docks, Staff, and Service Entrances 7. Tunnels ALARM & SECURITY DEVICES and SYSTEMS Right Device: is it properly installed; does it serve the intended purpose? Inspections: is the device inspected on a routine basis and maintained? Identifiable: are alarms coded or emit or transmit a distinct signal? Volume: can the alarm be heard in all or most areas and over various ambient sound levels? Staff Training: is staff aware of its presence, its intended use and shortfalls; do staff know how to properly use the device - turn it on, off, reset it? PAGE PAGE 1 PAGE PAGE 8 PAGE PAGE 20 PAGE PAGE 46 Resident is ambulatory or self-mobile in wheelchair? STOP NO YES New admission who has made statements questioning the need to be here or Resident is cognitively impaired, with poor decision-making skills, and/or pertinent diagnosis (e.g., dementia, OBS, Alzheimers, delusions, hallucinations, anxiety disorder, depression, manic depression, schizophrenia) or Resident is alert but non-compliant with facility protocols regarding leaving the unit. STOP NO YES STOP NO YES Resident has a history of wandering (either in the facility or elsewhere) or Opening doors to the outside and/or elopement or Is making statements that they are leaving or seeking to find someone/something or Displays behaviors, body language, etc. indicating an elopement may be forthcoming Care plan for high risk for elopement residents differentiating strategies for the cognitively intact vs. cognitively impaired individuals. Educate staff and enter notation on CNA care card. Utilize wander detection systems per manufacturers instructions as warranted Add the name of the resident with the wander detection system on the supervisors report Re-evaluate all interventions at least quarterly and verify the number on the wander detection device Notify security forward resident information and picture . / 0 1 7 D º 5 ¢ ® ùñéñùä äÞäÞäÞäÞäÞ˾vkUJ H h{+CJ aJ + jC H h{+CJ UaJ cH dh J&H hz+CJ aJ + jÖ) H hw+CJ UaJ cH dh J&H hw+CJ aJ + j H hË&CJ UaJ cH dh J&!j H h J&UmH nH uH hË&5CJ aJ $j H h J&5UmH nH u 5CJ aJ CJ aJ 5:CJ aJ 5:CJ aJ :CJ aJ . / 0 1 ý ô ô ô ô ý t $$If l Ö Ö ÿü$ &
11. [PDF] Florida Board of Pharmacy Controlled Substances Standards Committee ...
Jun 9, 2015 · substances told Medscape Medical News that shortages of these medications have grown steadily worse in recent ... Enter into the logbook the name ...
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12. [PDF] 608 SAN QUENTIN OPERATIONAL PROCEDURE TITLE ...
Mar 13, 2013 · These inmates would be subject to any local rules, policies, and procedures of the institution within which they are housed. No rules, ...
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13. [PDF] Ferguson Police Department General Order
Apr 25, 2011 · This affidavit shall be notarized. By order of: COLONEL THOMAS JACKSON. Chief of Police. Distribution. All Department Personnel. MPCCF Reference ...
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14. Drug Enforcement Administration, Department of Justice
Affected 347 Cite this Code: CFR To cite the regulations in this volume use title, part and section number. Thus, 21 CFR 1300.01 refers to title 21, part 1300, ...
21 U.S.C. 802, 821, 829, 871(b), 951, 958(f).
15. Public Law 106-554 - GovInfo
... all equipment and products purchased with funds made available in this Act should be American-made. (b) In providing financial assistance to, or entering into ...
16. [PDF] Comprehensive Cervical Cancer Control
• Determine the best treatment(s) available for the patient at the facility, taking into ... Document the following information in the vaccination logbook ( ...
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17. [PDF] Department of Obstetrics and Gynecology Residency Education ...
Oct 1, 2014 · All patients seen in clinic should be signed out by an Attending. ... The physician may delegate to a medical assistant or nurse the following.
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18. [PDF] City of Phoenix Fire Department Operations Manual Volume 1 Index
All medical treatment slips which are required shall be attached to the ... This form will be filled out for ALL sick leave occurrences except as noted below.
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19. [PDF] Catalog 2007–2008 | WSU Tech
completion of all Medical Assistant program first-semester coursework and competencies. MEA 131 Externship in Medical Assisting. 6.0 Cr Hrs. The application ...
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20. [PDF] Appendix A-E.xlsx - TN.gov
APPLICATION: All TDOC staff and staff of privately managed facilities under contract with the. TDOC. IV. DEFINITIONS: A. Annual Inspection/Compliance Review: A ...
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21. [PDF] Clinical Training of Medical Physicists specializing in nuclear Medicine
The application of radiation in human health, for both diagnosis and treatment of disease, is an important component of the work of the IAEA. The responsibility ...
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22. [PDF] SD Board of Pharmacy Meeting Minutes April 7, 2022, 1:00 p.m. ...
Apr 7, 2022 · In the case of the Vanderbilt nurse, where the patient died due to a medication error, there now is fear of retribution amongst the health care ...
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23. [PDF] ETHIOPIAN HOSPITAL SERVICES TRANSFORMATION GUIDELINES
When the patient is discharged these forms should all be entered into the MR before ... To ensure that all the patient's home medications are taken into.
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24. [PDF] L WASHINGTON - L'Aedica! Commission - Amazon AWS
Jun 12, 2018 · entered into by an individual physician or physician assistant and an individual pharmacist. ... u If patient has ANY of the following medical ...
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25. [PDF] Chapter 1 Policy and Procedure Manual Orientation and Use 1.1 ...
As changes are made, all JRF staff will be notified via Prevention. Link or e-mail. 1.2.3 POST ORDERS STATEMENT a. Each Juvenile Detention Officer is assigned ...
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