Have an account? Please log in.
Text size: Small font Default font Larger font
.
Radiology Daily
Radiology Daily PracticalReviews.com Radiology Daily

Dementia, Closed Head Injury Patients at Risk for Wandering

March 27, 2008
Written by: , Filed in: Practice Management
  • Comments
.

Serious health care errors in patient protection include items such as
discharging an infant to the wrong person, and patient injury or death related
to the patient wandering away from the facility without permission.

Patient protection events are included in one major category of serious
medical errors considered to be ‘never events’ as defined by the National
Quality Forum. The first item in this category is discharging an infant to the
wrong person.

This is a very rare situation and is different than an infant abduction.
Typically in these situations, someone arrives to take the infant home and
misrepresents themself (perhaps as a sister or cousin) as having been given
the authority to take the child home.

Situations like this more commonly occur when a healthy baby is discharged
before the mother or when a baby has needed prolonged hospitalization and the
mother was discharged earlier. To avoid this problem, health care facilities
need to have a system of double-checks to verify that the right person is
taking the baby home.

Another serious patient protection error is patient death or serious
disability associated with a patient leaving the facility without permission.
Patients who are most at risk for this problem are those who have a cognitive
impairment, but appear to be normal to the average person. Two groups of
patients who are at risk of wandering are patients who have any degree of
dementia and patients who have had a closed head injury and yet appear strong
and healthy.

These patients must initially be identified, and the risk for wandering, as
well as protective measures, must be documented. One protective measure may be
as simple as a brightly colored gown so that staff members will recognize that
this person is not to be wandering on the floor.

Other measures may include locators to help find a wandering patient, or other
technologies that sound an alarm when the patient tries to leave the floor.
Whatever measures are taken, this care plan must be carefully documented.

In addition, families must be involved with caring for patients at risk for
wandering. It can be difficult for families to understand that patients with
brain injury may look terrific but they have no judgment and are at risk for
hurting themselves in many ways.

Reference:
Kathleen Hale, RN, BSN, MHSA, and Richard P. Kidwell, JD Never Events:
Patient Protection Errors at Health Care Facilities

Serious health care errors in patient protection include items such as discharging an infant to the wrong person, and patient injury or death related to the patient wandering away from the facility without permission. Patient protection events are included in one major category of serious medical errors considered to be 'never events' as defined by the National Quality Forum. The first item in this category is discharging an infant to the wrong person. This is a very rare situation and is different than an infant abduction. Typically in these situations, someone arrives to take the infant home and misrepresents themself (perhaps as a sister or cousin) as having been given the authority to take the child home. Situations like this more commonly occur when a healthy baby is discharged before the mother or when a baby has needed prolonged hospitalization and the mother was discharged earlier. To avoid this problem, health care facilities need to have a system of double-checks to verify that the right person is taking the baby home. Another serious patient protection error is patient death or serious disability associated with a patient leaving the facility without permission. Patients who are most at risk for this problem are those who have a cognitive impairment, but appear to be normal to the average person. Two groups of patients who are at risk of wandering are patients who have any degree of dementia and patients who have had a closed head injury and yet appear strong and healthy. These patients must initially be identified, and the risk for wandering, as well as protective measures, must be documented. One protective measure may be as simple as a brightly colored gown so that staff members will recognize that this person is not to be wandering on the floor. Other measures may include locators to help find a wandering patient, or other technologies that sound an alarm when the patient tries to leave the floor. Whatever measures are taken, this care plan must be carefully documented. In addition, families must be involved with caring for patients at risk for wandering. It can be difficult for families to understand that patients with brain injury may look terrific but they have no judgment and are at risk for hurting themselves in many ways. Reference: Kathleen Hale, RN, BSN, MHSA, and Richard P. Kidwell, JD Never Events: Patient Protection Errors at Health Care Facilities [text_ad]
.

Permalink: http://www.radiologydaily.com/?p=2648

Tags: , , , , , , , , , ,

  • Comments
.

Would you like to keep current with radiological news and information?

Post Your Comments and Responses

Comments are closed.