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Absconded
Out on pass
1. Out on pass is an inpatient who is temporarily absent from a
ward, by arrangement, for not more than 48 hours because:
...
POLICy:
-Is to provide proper steps, prompt and sufficient
response to the situation, guide in place that formalize
how st...
Out on pass
1. Patient must pass through the admission procedure and completed preoperative workup before allowed to
leave...
1. A patient that has been seen and haven’t been seen yet, but
the facility has touched them, they signed in and then they...
3. Steps to take when patient verbalized DAMA plan:
1. The nurse must notify the attending physician or resident on-duty
r...
Absconded- Patient who left the hospital without:
2.1.1. Proper discharge procedures
2.1.2. Asking the physician or nurse’...
Absconded patient can be categorized into:
1. HIGHRISK-patient is an individual who present a risk to themselves and/or ot...
RESPONSIBILITIES:
1. THE STAFFNURSE:
1.1. ENSURE THAT PATIENT IS ABSCONDED AND DETERMINES THE EXACT
TIME OF DISCOVERING TH...
3.2. To ensure full record in the patient’s medical record.
3.3. To complete the absconded form.
4. Socialworker/Directoro...
POLICY:
1. The policy applies to all inpatients across MGH.
2. Patient is categorized as absconded if he / she is not on b...
2.2. If the patient moderate or low risk:
2.2.1. The nurse who discovered the absconding patient will report the
incident ...
5. Police involvementin all casesof absconded:
5.1. Criteria before contacting the police service:
1. High risk, Critical ...
2. Patients who absconded but who either return voluntarily or brought back by
the police back to emergency department and...
2. Authentication of Medical Record Entries:
1. Correctly identify patients should be made prior to
documenting
2. Initial...
5. Users shall not share their account(s), passwords, (PIN),
Security tokens (e.g., Smartcard), or similar information
or ...
“If it wasn’t written down, it didn’t happen.”
4. Chronological Entries:
1. It is strongly recommended that all materials ...
.
Electronic documentation with these
systems can help decrease documentation
deficiencies and errors, as well, since an
E...
5. Every entry must be dated, timed, and signed (can be
initial).
6. For non- computer documentation of FLOWSHEETS:
a. Pla...
6. Error Correction Process:
1. At no time is it permissible to obliterate or remove a
previous entry in the medical recor...
b. When an error is made in an electronic medical
record entry, the following error correction must be
followed:
i. An “Ad...
9. History and Physical
1. A History and Physical Examination (H&P) is required for all
hospital admissions (adequate for ...
IPSG – 6 (REDUCE THE RISK OF PATIENT HARM RESULTING FROM
FALLS)
Dama,absconded & out on pass med staff responsibility
Dama,absconded & out on pass med staff responsibility
Dama,absconded & out on pass med staff responsibility
Dama,absconded & out on pass med staff responsibility
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Dama,absconded & out on pass med staff responsibility

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BY. Sis. NURZIA J. PASIL
QPSD-risk management officer
Meeqat General Hospital Complex madinah, KSA

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Dama,absconded & out on pass med staff responsibility

  1. 1. Absconded Out on pass
  2. 2. 1. Out on pass is an inpatient who is temporarily absent from a ward, by arrangement, for not more than 48 hours because: 1. (S)he has been allowed to go home temporarily. 2. (S)he has been transferred to another hospital and is expected to return. 3. (S)he has been transferred from a long stay specialty to another specialty in the same hospital and is expected to return 2. DAMA- Discharge Against Medical Advised 1. Is a “self-discharge” or “discharge at own risk” occurs when a patient chooses to leave the hospital before the treating physician recommends discharge. THEY HAVEN’T BEEN SEEN YET, BUT THE FACILITY HAS TOUCHED THEM., THEY SIGNED IN AND THEN THEY DECIDED TO LEAVE, ALL OF THESE CAN BE CONSIDERED DAMA. 2. If an out on pass patient failed to come on specified time decided by his physician or his/her designee. 3. Absconded- Patient who left the hospital without: 1. Proper discharge procedures. 2. Asking the physician or nurse’s permission out on pass.
  3. 3. POLICy: -Is to provide proper steps, prompt and sufficient response to the situation, guide in place that formalize how staff respond to a patient refusal, including careful documentation processes and follow-up when patient; 1. By arrangement, leave the hospital at specified time that is not more than 48 hours. OUT ON PASS 2. If an out on pass patient failed to come on specified time decided by his physician or his/her designee. (DAMA) 3. When a patient chooses to leave the hospital before the treating physician recommends discharge. DAMA 4. Patient who left the hospital without proper discharge procedures. (ABSCONDED) -It provides guide for the staff in documenting accurate assessment of RISK, criteria and legal responsibility on the patient file. -Avoid confrontations and respect a patient’s right to refuse- Offer alternatives to the care being refused.
  4. 4. Out on pass 1. Patient must pass through the admission procedure and completed preoperative workup before allowed to leave the hospital. 2. A therapeutic pass may only be issued under a provider order, after assessment that must specify : 2.1. The length of time the patient is authorized to be absent from the unit based upon assessment of his/ her medical condition and intervention he/she might need to come back before leaving the hospital. 2.2. The reason for the absence 2.3. Any special instructions related to the pass. 3. Upon the patients return, department nurse staff would then chart the time returned, who they were with when returning, & general condition . 4. The patient must be informed that failure to return to the unit within their expected return time may result in the patient being discharged as DAMA and losing their bed.
  5. 5. 1. A patient that has been seen and haven’t been seen yet, but the facility has touched them, they signed in and then they decided to leave, all of these can be considered DAMA. DAMA 2. If the general condition of the patient is critical and there is life threatening clinical condition, the patient relation personnel and social worker will be informed to support the treating physician and explain to the patient and his / her family who wish to leave the hospital and document these reasons in the patient file. 3. The hospital must reconcile any outstanding diagnostics results: Any tests were ordered, the hospital is still responsible for checking the results to be sure nothing serious was identified and if there is significant results came out after patient discharge, the patient must be contacted and informed
  6. 6. 3. Steps to take when patient verbalized DAMA plan: 1. The nurse must notify the attending physician or resident on-duty regarding patients desire to go for DAMA 2. If the patient(and or family) cooperates and his / her clinical condition is not critical and requesting to leave against medical advice, the reasons behind his / her leave has to be discussed if can be solved and continue his / her management by the treating physician together with social worker. 3. If the same patient still insisting to leave the department for personal reasons, he / she will sign the General Consent (DAMA) Form, the treating physician, nurse must countersign his /her signature and signature from administration on duty or patients affair for clearance. 4. The discharge summary should includes all patient medical and surgical data, the plan of treatment, bring home medications ordered by the treating physician and any other recommendations and how to communicate the hospital in case of top emergency.
  7. 7. Absconded- Patient who left the hospital without: 2.1.1. Proper discharge procedures 2.1.2. Asking the physician or nurse’s permission out on pass. Risk factors of absconded patient: 1. There is a link between absconding and to serious self-harm, lesser extent to violent behavior. 2. Absconding can also result in serious self-neglect which can lead to death. 3. Absconding may lead to catastrophic loss of confidence by relatives who expect the hospital to be a 'place of safety'. 4. When things do go wrong, there is a possibility that legal action may be taken
  8. 8. Absconded patient can be categorized into: 1. HIGHRISK-patient is an individual who present a risk to themselves and/or others. 1.1. Rapid deterioration (life saving) in physical condition. 1.2. Those patients who are an immediate risk and have a significant likelihood to suffer harm to them as an individual or as a threat to others. 1.3. An extremely young or an extremely old person. 1.4. Patient who is assessed as likely to attempt significant self-harm or suicide. 1.5. A patient who does not have the mental capacity to make a decision 1.6. At risk of spread of infection to community( eg. MERS) 2. Medium risk- is an individual who not considered to present any danger to themselves and/or others. 2.1. A little risk of deterioration in their physical condition due to being outside the hospital. 2.2. A patient that is assessed as likely to come to harm without medical assistance. 3. Low risk patient is not considered to present any danger to either themselves or other. These are patients who are willingly absent, but are able to function adequately without assistance and are unlikely to come to harm under normal circumstances. It would also cover cases where despite consideration of known risk factors, there are still no grounds for believing the missing person is likely to come to harm.
  9. 9. RESPONSIBILITIES: 1. THE STAFFNURSE: 1.1. ENSURE THAT PATIENT IS ABSCONDED AND DETERMINES THE EXACT TIME OF DISCOVERING THAT THE PATIENT ABSCONDED OR THE TIME OF RETURN. 1.1. TO INFORM THE RESPONSIBLE PHYSICIAN THAT THE PATIENT WAS ABSCONDED/MISSED. 1.2. TO INFORM DIRECT LINE MANAGER. 3.1.4. DOCUMENTS INCIDENT REPORT (OVR FORM). 3.1.5. DOCUMENT WHAT IS HAPPENED IN THE PATIENT’S FILE 2. DIRECTLINEMANAGER: 2.1. TO INFORM THE SECURITY AND START SEARCHING FOR THE PATIENT. 2.2. TO INFORM THE DIRECTOR ON-DUTY/ADMINISTRATOR. 2.3. TO INFORM SOCIAL WORKER AND OR PATIENT’S RELATIONS. 2.4. TO INFORM THE POLICE, IF INDICATED. 2.5. TO FILL THE ABSCONDED FORM . 3.PHYSICIAN IN CHARGE 3.1. TO DETERMINE HIGH-RISK PATIENT, NEEDED TO BE ALLOCATED AND RECALL.
  10. 10. 3.2. To ensure full record in the patient’s medical record. 3.3. To complete the absconded form. 4. Socialworker/Directorondutyin pm/nightshiftandweekends.: 4.1. To collect all personal information. 4.2. To contact the relatives and inform them about the situation. 4.3. To discuss with the patient the reasons of leaving and the ability to back again. 5. Headof security(Policeofficer): 5.1. Responsible for patient safety and medical legal implication. 6. AdmissionOfficer/Reception(SelfResources Administration): 7.1. Provides patients information and admission status.
  11. 11. POLICY: 1. The policy applies to all inpatients across MGH. 2. Patient is categorized as absconded if he / she is not on bed for one (1) hour after thorough search by Nursing Staff and Security Officer 2.1. Bed is blocked for six (6) hours. Patient will be discharged after 6 hours. 2.2. Discharge should be accomplished by the Physician as soon as possible.- 3. Determine the high-risk patient need to be allocated and recall again to ED. Procedures: 1. Determine absconded- If the patient identified out of bed/missing after one (1) hour. 2. Stepsto be taken: 2.1. If the patient high risk: The charge nurse will assign some staff nurse and security, to search the patient immediately without waiting for return of the patient by himself, in the corridors, bathrooms, visiting his neighbor patients, and external to the ED or hospital unit.
  12. 12. 2.2. If the patient moderate or low risk: 2.2.1. The nurse who discovered the absconding patient will report the incident to his/her direct line manager. 2.2.2. The charge nurse can wait for one hour to alert the security and start searching of the patient. 2.2.3. At the same time gather all available information concerning the situation 3. Reviewthe situationof the patient: 4.1.History of previous event of going absconded either from hospital or at home, it will be necessary to check patient record or information if relatives are available.: 4. Recallback thepatient to ED/Unit: 4.1. The social worker and patient relationship will collect all the personal information of the patient and RECALL patient back to the hospital. 4.2. If the patient informed, a maximum of six hours will be allowed for him or his relative to return from the time he/she leaves the hospital
  13. 13. 5. Police involvementin all casesof absconded: 5.1. Criteria before contacting the police service: 1. High risk, Critical patient level I & II. 2. Confused, dementia, aged, or drug addict. 3. Female, child and in-competent patient. 4. Disabled or handicapped. 5. Leaving the hospital with central or peripheral lines. 6. History of self-harming. 5. 2. Contacting the police as the correct course of action must be decided by both charge nurse and concern doctor due to some legal issues. 6. Hospitalright: The hospital will not be responsible 6.1. For any sequel or complication in this condition 6.2. Any illegal act done in this period. 7.Patientswho return: 7.1. The patient must be seen and re-assess by the doctor. 1. Re-assessment will be done and previous management plan will be changed base in the light of new clinical evaluation.
  14. 14. 2. Patients who absconded but who either return voluntarily or brought back by the police back to emergency department and or unit should be considered as: 2.1. High risk for further episodes of absconding and their clinical assessment must be priorities. 2.2. Patient may have changed condition due to: 2.2.1. Ingestion 2.2.2. Alcohol intake 2.2.3. Drugs 2.2.4. Abuse (self-harm) etc. 8. Prevention of absconding: 1. If the patient is adamant to leave even after all effort given by medical staff to stay, then discharge patient with option to choose against medical advise ( ref to policy of DAMA) but if the patient still to refuse the said option, then patient is considered as ABSCONDED. 9. Documentation: 1. Complete ABSCONDED form. Make sure all concerned staff in the designated area and space has been filled up with their side and signed. 2. Only after obtaining discharge order from the physician after 6 hours discharge is confirmed, then nurse must release now the patient record from the unit system as ABSCONDED. 3. Write an incident report (OVR).
  15. 15. 2. Authentication of Medical Record Entries: 1. Correctly identify patients should be made prior to documenting 2. Initials can only be used on medical record forms approved by the organization,such as flow sheets, medication records or treatment records. 3. All entries shall be signed or initialed/authenticated by the provider. Signatures must include first name or initial, last name, and employment/status (e.g., SOD) or licensure status (e.g., M.D.). Initials alone are not acceptable 4. For authenticating paper medical record documentation, handwritten signatures may be accompanied either by the author legibly writing his/her name in block print or by the use of a name stamp accompanied by a signature.
  16. 16. 5. Users shall not share their account(s), passwords, (PIN), Security tokens (e.g., Smartcard), or similar information or devices used. Individual identified by the electronic signature or method of electronic authentication is the only individual who may use it, as it denotes authorship of medical record documents in electronic medical records. 3. Timing and Dating of Entries: 1. All entries must be timed and dated. 2. Record times based upon 24-hour military time. 3. It is recommended that entries be recorded as closely as possible to the time of the encounter. 4. It is recommended that all paper-based entries in the papers must be in black or blue ink . Entries should not be made in pencil.
  17. 17. “If it wasn’t written down, it didn’t happen.” 4. Chronological Entries: 1. It is strongly recommended that all materials in the medical record be organized in a chronological and systematic manner. 2. An entry should never attempt to preserve the chronological order of the interaction/intervention date and time by entering an artificial or inaccurate documentation date and time. 3. When clinical documentation is entered out of chronological order, it is a 'late entry' and shall identify: 5. Legibility and Clarity: 1. Regulations require that medical records be legible. 2. Do not use text message language in documentation 3. Do not use unapproved abbreviations. 4. Document in blue or black ink; no felt-tip pen.
  18. 18. . Electronic documentation with these systems can help decrease documentation deficiencies and errors, as well, since an EHR system’s prompts remind a nurse to
  19. 19. 5. Every entry must be dated, timed, and signed (can be initial). 6. For non- computer documentation of FLOWSHEETS: a. Place an “√” in the boxes that apply or circle the appropriate responses. b. If a subject on the flowsheet requires a written response, and the response is not applicable, write “NA” in the corresponding space. 7. Documentation of a NARRATIVE NOTES: 1. Each page (front and back if two-sided) must be dated and notes must have the first initial, full last name, and credentials of individual documenting on the sheet.
  20. 20. 6. Error Correction Process: 1. At no time is it permissible to obliterate or remove a previous entry in the medical record (paper or electronic). Note: When using late entries, document as soon as possible. There is no limit to writing a late entry, however, keep in mind that the more time passes, the less reliable the entry becomes. a. When an error is made in a paper-based medical record entry, the following error correction procedures must be followed: i. Draw a line through the entry. Make sure the inaccurate information is still legible. ii. Do not write error on the line. iii. Sign and date the entry. vi. Do Not obliterate or otherwise alter the original entry by blacking out with marker, using whiteout or writing over an entry.
  21. 21. b. When an error is made in an electronic medical record entry, the following error correction must be followed: i. An “Addendum” note should be dictated or typed referencing the incorrect documentation or dictation no. ii. When correcting or making a change to an entry in the computerized medical record/ (EHR), the original should be viewable, the current date and time should be entered, the person making the change should be identified, and the reason should be noted. 7. System Downtime (Electrical Shutdown): 1. Refer to department downtime protocol. 8. Use of Cloned Documentation in the Electronic Medical Record 1. Previously entered data, when used in a new note, should always meticulously updated and edited.
  22. 22. 9. History and Physical 1. A History and Physical Examination (H&P) is required for all hospital admissions (adequate for the duration of the hospital stay). 10. Do not falsify any document. 1. Creation of purposely inaccurate entries or documentation 2. Back-dating entries 3. Pre-dating entries
  23. 23. IPSG – 6 (REDUCE THE RISK OF PATIENT HARM RESULTING FROM FALLS)
  • IdrisAlnoor1

    Mar. 28, 2020

BY. Sis. NURZIA J. PASIL QPSD-risk management officer Meeqat General Hospital Complex madinah, KSA

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