Could a child in need of help walk out of your ED?

Don't let child 'seize the opportunity to elope'

A child who was involuntarily committed managed to walk out of the ED at All Children's Hospital in St. Petersburg, FL, right past a security guard and out the main hospital doors.

"All this could have been prevented if the patient had their clothing removed and a sitter or assigned staff was with the patient," says Scott Phillips, RN, clinical nurse leader.

Luckily, the patient was retrieved by a staff member four miles away in a residential neighborhood. "This outcome was fortunate for all involved," says Phillips.

In another case, the sitter assigned to a 17-year-old was not trained adequately to stop the determined teen from leaving. "The nurse who was responsible did not have him in a room that was visible to all staff, security was not notified, the patient's clothes were not removed, and there was no identification bracelet given," says Phillips.

Since the ED isn't a secure unit, the patient had direct access to the exit. "He left and was not retrieved," says Phillips. "I have been told of a person at another ED who eloped and actually committed suicide by lighting himself on fire in a Dumpster."

Vulnerable times for the ED include traumas or codes involving other patients, or periods of high volume. "When your staff is distracted and the patient seems normal and compliant, that is the time the patient seizes the opportunity to elope," says Phillips.

The ED nurse is the one who can "prevent the situation from getting out of control before it actually does," says Phillips. Here is the new process used to prevent pediatric psychiatric patients from leaving without treatment:

  1. The patient is placed in a room across from the nurse's station.
  2. A pink sticker is placed on the chart and outside the door to alert other staff members to keep an eye out for him or her.
  3. Security is informed of the arrival of the patient. "Security presence is increased, and everyone in the department is put on alert," Phillips says.
  4. The patient is asked to change into a hospital gown, with the clothing placed in a bag to be held at the nurse's station.

Misty N. Eiler, RN, BSN, clinical nurse leader in the hospital's emergency center, says, "This makes it much easier to spot an eloped patient outside the hospital and keeps them from wanting to leave without their belongings."

Patients also are placed on pulse oximetry and cardiac monitors, especially for ingestions. "This makes it more difficult to leave the room, with all the wires. If the patient tried to leave, it would trigger the monitors to alarm at the nurse's station for someone to check on them," says Eiler.

If there is not a parent present, a sitter remains at the bedside at all times while the patient remains in the ED.

Compliance is 100%

The ED's program already has proved to be successful, says Phillips. "Security and nursing staff have been 100% compliant. This has decreased the opportunities that crafty psych patients often see as a chance to leave the hospital," he says.

The ED nurse has the "hardest and most important role" in this process, says Phillips. "The role of the ED nurse is to prevent any hostile interaction and aggression as long as possible from both the patient and staff," he says.

In the near future, card access will be required to get in and out of the ED. "This will further enhance our security and safety for the psych patient population," says Phillips.