10 Steps to Preventing Patient Elopement

Patient elopement is when individuals leave an area they are expected to stay within, for their safety. Elopement from a healthcare facility can have devastating consequences for a patient, including serious injury or death. 

Oftentimes, resources on elopement are specific to the aging services setting since most elopements occur among older adults who have been diagnosed with Alzheimer's disease or dementia; however, elopement can present a risk for all manner of patients, particularly behavioral health patients and patients with altered mental status. 

To prevent elopement, it is important to develop policies and procedures on what to do in the event of an elopement. Organizations should perform individualized assessments of elopement risk, develop person-specific interventions, and evaluate the interventions' effectiveness in managing the individual's behavior. Staff must follow these established procedures in a timely manner when an elopement occurs. In addition, the facility can consider installing environmental safeguards (e.g., barriers or buffers, windows and door locks) to aid in elopement prevention. 

According to the Agency for Healthcare Research and Quality, patients should be assessed for elopement risk on admission and throughout their hospital stay. If a patient is deemed at risk for elopement, they should be put on special preventive precautions. See this Elopement Risk Decision Tree from Joint Commission Resources for an example. 

Consider the following elements when developing an elopement prevention program: 

1. Define elopement in policies, procedures, and training materials. 
2. Assess the patient's risk of elopement at the time of admission and periodically throughout the patient's stay. 
3. Identify criteria that would designate the patient as at risk for elopement (e.g., mobility, mental status, observed behaviors or statements, previous elopement attempts, drug or alcohol withdrawal, psychotic episodes). 
4. Use a decision tree or other decision-making tool to foster compliance with assessment completion. 
5. Document elopement-risk assessment findings, strategies implemented to address identified risks, and a rationale for the chosen interventions. 
6. Use environmental safeguards to help prevent elopement (e.g., barriers or buffers, window and door locks, video surveillance, patient tracking devices). 
7. Utilize activities that help redirect a patient's focus (e.g., social interactions, physical activity, movies, pet therapy). 
8. Create an incident response protocol that staff can easily activate when a patient is missing. The protocol should specify the sequence of events (e.g., the action plan) that should take place when staff are notified that a patient is missing. The protocol should include the communication plan (e.g., notification of unit supervisor, security, patient's physician, patient's family, administration) and must include up-to-date contact information for all parties who need to be notified. 
9. Ensure that all staff are educated about preventing and responding to elopement events (e.g., risk factors, communication protocols, action plans). 
10. Evaluate elopement events and attempted elopement events to identify gaps in the protocol or in staff education or response. Modify the protocol as needed. 

Additional Resources 

• Elopement Risk Decision Tree (Joint Commission Resources) 
• Spotlight Case: Elopement (AHRQ Patient Safety Network) 
• Hospital Issues New Guidelines for Elopement Risk (Yale New Haven Health) 
• Patient Elopement: Widespread, but Rarely Discussed (HealthLeaders) 
• Wandering Off the Floors: Safety and Security Risks of Patient Wandering (AHRQ Patient Safety Network) 
• Management of Wandering and Missing Patients (Veterans Health Administration) 
• Toolkit: Patients At Risk for Wandering (Veterans Health Administration)

Learn how ECRI can help you reduce risk, support safety efforts, and achieve better outcomes with our comprehensive approach to safety.