Community Hospitals & Day Services Absconding or missing patient procedure

Purpose

This Standard Operating Procedure (SOP) provides NHS Borders Community Hospital and Day Services staff with direction and structures in the event of a patient going missing from hospital premises.

Course of Action to be taken by NHS Borders staff

When a patient is identified as being “missing” from the clinical area, all staff must inform nurse in charge of clinical area, who is responsible for coordinating initial response.

Wards being the most common area in the hospital, it is probable that a patient will be reported missing from their ward. Should a patient go missing from any other area of the hospital, the patient’s ward must be notified immediately and the search procedure will be activated.

Stage 1
Nurse in charge of clinical area must:

• Record time patient identified as missing, and by whom.
• Establish from staff on duty and other patients when patient was last seen, a description of the patient and what they were wearing (check locker/personal belongings if necessary).
• Delegate staff to undertake preliminary search of the clinical area, taking into account patient’s daily routine or usual patterns of behavior if known.
• It is important that the initial search be carried out systematically to ensure that no area is omitted, it is necessary in the initial search to verify that the patient is not in a room which has the lock engaged.
• The senior charge nurse/nurse in charge should after having carried out the initial search of their ward area, notify other wards/departments in the building to search their areas.
• Ensure all exits to main building are checked.
• Deploy two staff to check immediate perimeter of main hospital block, including care parks and site entrances.
• Check CCTV (if available) for sightings of the missing patient and ensure police have access to view system.
• Deploy staff to check public areas and stairwells.

Precautions must be taken to ensure the safety of staff when initiating a search. Please refer to Prevention and Management of Aggression and Violence (PMAV) Policy (Incorporating Personal Safety/Lone Working/Safe Driving).

If the patient is seen by staff to be leaving the building, staff should attempt to encourage the patient to remain within the Community Hospital.

• Two staff (if staffing levels permit) should follow patient if safe to do so with a mobile phone. Attempts should be made to encourage the patient back to the building maintaining a safe distance.
• Staff should follow the patient and alert the police of the patient’s whereabouts, if deemed necessary. They should only continue to follow the patient in the grounds of the hospital and maintain a safe distance for safety.
• If staff manage to encourage the patient to return to the ward, this must be done using a safe process either by foot or NHS vehicle.
• If an NHS vehicle is used two staff must be present and safety locks and seat belt used.
  If there is a significant risk to self or others and person has been witnessed leaving the hospital grounds move to Stage 2, or if initial search is unsuccessful after 30 minutes, move to Stage 2.

Stage 2 (no later than 30 minutes after the initial report)

Nurse in charge of clinical area must:

• Inform police if patient not found after first search of local area and wider hospital.
• Provide police with a Single Point of Contact (SPOC) for any future communication during the investigation and agree to meet on ward.
• Inform the Clinical Nurse Manager or On Call Manager (out of hours).
• Unless there is a strong possibility of the patient heading for home, relatives should not be advised until the initial search of the hospital has been completed. Once initial search has been completed Nurse in Charge will inform the relatives after consultation with police.
• If relatives are present in the ward, sensitively suggest that they go home or make arrangements so that someone is at the missing persons home in case they turn up there.
• Record all conversations accurately in nursing record.
• Support staff involved.

If the patient is not located, the Police will maintain regular contact with SPOC.

It is recognised by NHS Borders that at times situations arise that cannot be predicated and clinical judgment of the situation/event may require other actions to ensure safety of patients and staff.

Reporting a Missing Person to Police Scotland

Prior to reporting a patient as missing to the police, it is expected NHS Borders staff will have completed all reasonable local measures.

Essential actions must include:

• A search of the ward to ensure the patient has not been missed.
• A search of the local vicinity of the ward buildings.
• Check the patient’s belongings, taking particular note of any evidence of the patient having finalised their affairs. It is also important to note if the patient has taken all or some of their belongings.
• Collated patient description details as per Appendix 1.
• Where relevant and necessary arrange for any CCTV footage to be reviewed for the relevant period.
• Contact has been made with the patient’s next of kin and/or any family members or associates where appropriate.
• Inform the Clinical Nurse Manager or On Call Manager (out of hours) that you are making a Missing Person report to the police.

If the patient concerned has a diagnosis of Dementia or is cognitively impaired requiring support to remain safe, they should have a Herbert Protocol form completed and filed in their care plan. The information on this form will support Police in their search.

It is vital that if an immediate concern exists for the safety of the missing person or others then Police Scotland should be contacted without delay.

Once the Missing Person is Traced

When a Missing Person returns to the ward, staff will:

• Notify Police Scotland immediately, if they are not already aware, for example when the Missing Person returns on their own or without police intervention.
• Assess for any immediate medical attention.
• Make a current mental state assessment.
• Check for signs of self-harm or ingestion of stimulants.
• Consider current risk to self and/or others.
• Consider the need to raise their engagement and observation status or implement any additional provisions contained within Mental Health (Care and Treatment) (Scotland) Act 2003.
• Inform other relevant parties of the patient’s return – Next of Kin, family, medical team and Clinical Nurse Manager or On Call Manager (out of hours).
• Record incident and actions via DATIX and in patient’s medical record.

Media Enquiries

In some cases decisions will have to be made regarding a press release/appeal in relation to a missing person. This decision will be made through the Police Senior Investigating Officer for the enquiry and the Communications Team, NHS Borders as per our Media Relations Policy.