United States Department of Veterans Affairs

National Center for Patient Safety

VHA NCPS Escape and Elopement Management

START -
How To Use This Aid

How To Use This Aid

This aid is intended to prompt the user to consider a wide variety of interventions to prevent patients from escaping and eloping from VA buildings and grounds. We have ordered the suggested interventions from the most desirable(1st degree) to the most restrictive(4th degree). It is important to consider that each patient is an individual with particular likes and dislikes. Not all suggested measures may work. Some measures may need to be used at specific times of the day or under certain circumstances.

Be flexible and creative in your approach. You may want to consider combinations of the suggested interventions. We also suggest that you involve the family as much as possible and question them on your patient's likes and dislikes to direct you when considering which interventions to implement.

Some interventions require physical alterations to the patient care area and should be considered whenever appropriate. Simpler environmental interventions may be possible with a little creativeness and cooperation with varying services at your facility. It is not the intent of this tool to recommend a specific environmental renovation, rather to support the pursuit of functional unit design as needed.

Patients may have a variety of disorders. Ensure that underlying conditions are assessed through a complete history and physical. Always assess the patient first!

  1. First, go to the Risk Assessment tab to determine if your patient is an escape or elopement risk.
    If yes, proceed to the specific behaviors you see the patient exhibiting for suggested interventions.
  2. Go to other tabs to find the least restrictive diversional activities first before progressing into the more restrictive measures.
Risk
Assessment

Risk Assessment

If any of the following questions are answered "yes" then consider the patient to be a risk for escape or elopement.
  • Does this patient have a court appointed legal guardian?
  • Is this patient considered to be a danger to self or others?
  • Has this patient been legally committed?
  • Does this patient lack the cognitive ability to make relevant decisions?
  • Does this patient have a history of escape or elopement?
  • Does this patient have physical or mental impairments that increase their risk of harm to self or others?
Anxiety

Anxiety

  • 1st Degree Intervention - Diversional Activities:
    • Aromatherapy
    • Change of Staff
    • Familiar Objects/Possesions
    • Family or Volunteer
    • Group
    • Hobbies
    • Pet Therapy
    • Reading
    • Rocking
    • Movies
    • Social Interaction
    • Walks
    • Orientation/Reorientation to Unit
    • Regular Exercise
    • Musical (group/individual, listening/playing, familiar styles/songs)
    • Purposeful Activities (make bed, clean room, fold towels, etc.)
    • Therapeutic Touch (object textures, physical contact)
  • 1st Degree Intervention - Monitoring Activities:
    • One to One
    • Review Medications
    • Location Checks
  • 2nd Degree Intervention - Environmental Enhancements:
    • Therapeutic Decor (Aviaries, Aquariums, Plants, etc.)
  • 3rd Degree Intervention - Environmental Design:
    • Color Schemes to identify unit
    • Locator Maps
    • Circular Unit Design
    • Clearly marked signs that can be easily read
    • Clearly mark patient's room
    • Change Lighting
    • Quiet Room
    • Reality Orientation Board
  • 4th Degree Intervention - Environmental Design:
    • Locked Unit
Confusion

Confusion

  • 1st Degree Intervention - Diversional Activities:
    • Change of Staff
    • Family or Volunteer
    • Familiar Objects/Possesions
    • Group
    • Hobbies
    • Pet Therapy
    • Reading
    • Rocking
    • Movies
    • Social Interaction
    • Walks
    • Orientation/Reorientation to Unit
    • Regular Exercise
    • Musical (group/individual, listening/playing, familiar styles/songs)
    • Purposeful Activities (make bed, clean room, fold towels, etc.)
    • Therapeutic Touch (object textures, physical contact)
  • 1st Degree Intervention - Monitoring Activities:
    • One to One
    • Location Checks
  • 2nd Degree Intervention - Environmental Enhancements:
    • Therapeutic Decor (Aviaries, Aquariums, Plants, etc.)
    • Soft Door Barriers
    • Soft Door Knobs
    • Dark Flooring to create perceived voids in floor
  • 3rd Degree Intervention - Environmental Design:
    • Color Schemes to identify unit
    • Locator Maps
    • Clearly mark patient's room
    • Circular Unit Design
    • Reality Orientation Board
    • Quiet Room
    • Change Lighting
    • Clearly marked signs that can be easily read
    • Camouflage doors (exit signs must remain)
  • 4th Degree Intervention - Environmental Design:
    • Door Alarms
    • Tracking system
    • Locked Unit
Depression

Depression

  • 1st Degree Intervention - Diversional Activities:
    • Aromatherapy
    • Change of Staff
    • Family or Volunteer
    • Familiar Objects/Possesions
    • Group
    • Hobbies
    • Pet Therapy
    • Reading
    • Rocking
    • Movies
    • Social Interaction
    • Walks
    • Orientation/Reorientation to Unit
    • Regular Exercise
    • Musical(group/individual, listening/playing, familiar styles/songs)
    • Purposeful Activities (make bed, clean room, fold towels, etc.)
    • Therapeutic Touch (object textures, physical contact)
  • 1st Degree Intervention - Monitoring Activities:
    • One to One
    • Location Checks
  • 2nd Degree Intervention - Environmental Enhancements:
    • Therapeutic Decor (Aviaries, Aquariums, Plants, etc.)
  • 3rd Degree Intervention - Environmental Design:
    • Color Schemes to identify unit
    • Change Lighting
    • Reality Orientation Board
  • 4th Degree Intervention - Environmental Design:
    • Door Alarms
    • Tracking system
    • Locked Unit
Escape

Escape

  • 1st Degree Intervention - Diversional Activities:
    • Change of Staff
    • Family or Volunteer
    • Familiar Objects/Possesions
    • Group
    • Hobbies
    • Pet Therapy
    • Reading
    • Movies
    • Social Interaction
    • Walks
    • Regular Exercise
    • Musical(group/individual, listening/playing, familiar styles/songs)
    • Purposeful Activities (make bed, clean room, fold towels, etc.)
    • Therapeutic Touch (object textures, physical contact)
  • 1st Degree Intervention - Monitoring Activities:
    • One to One
    • Location Checks
  • 2nd Degree Intervention - Environmental Enhancements:
    • Therapeutic Decor (Aviaries, Aquariums, Plants, etc.)
  • 3rd Degree Intervention - Environmental Design:
    • Circular Unit Design
    • Reality Orientation Board
  • 4th Degree Intervention - Environmental Design:
    • Door Alarms
    • Tracking system
    • Locked Unit
General
Restlessness

General Restlessness

  • 1st Degree Intervention - Diversional Activities:
    • Aromatherapy
    • Family or Volunteer
    • Familiar Objects/Possesions
    • Group
    • Hobbies
    • Pet Therapy
    • Reading
    • Rocking
    • Movies
    • Social Interaction
    • Walks
    • Regular Exercise
    • Musical (group/individual, listening/playing, familiar styles/songs)
    • Purposeful Activities (make bed, clean room, fold towels, etc.)
    • Therapeutic Touch (object textures, physical contact)
  • 1st Degree Intervention - Monitoring Activities:
    • One to One
    • Location Checks
  • 2nd Degree Intervention - Environmental Enhancements:
    • Therapeutic Decor (Aviaries, Aquariums, Plants, etc.)
    • Soft Door Barriers
    • Soft Door Knobs
  • 3rd Degree Intervention - Environmental Design:
    • Color Schemes to identify unit
    • Locator Maps
    • Clearly mark patient's room
    • Circular Unit Design
    • Quiet Room
    • Change Lighting
    • Clearly marked signs that can be easily read
    • Camouflage doors (exit signs must remain)
  • 4th Degree Intervention - Environmental Design:
    • Door Alarms
    • Tracking system
    • Locked Unit
Hallucinations/
Delusions

Hallucinations/Delusions

  • 1st Degree Intervention - Diversional Activities:
    • Review Medications
    • Family or Volunteer
    • Familiar Objects/Possesions
    • Hobbies
    • Group
    • Movies
    • Pet Therapy
    • Walks
    • Reading
    • Rocking
    • Regular Exercise
    • Social Interaction
    • Orientation/Reorientation to Unit
    • Musical(group/individual, listening/playing, familiar styles/songs)
    • Purposeful Activities (make bed, clean room, fold towels, etc.)
    • Therapeutic Touch (object textures, physical contact)
  • 1st Degree Intervention - Monitoring Activities:
    • One to One
    • Location Checks
  • 2nd Degree Intervention - Environmental Enhancements:
    • Therapeutic Decor (Aviaries, Aquariums, Plants, etc.)
  • 3rd Degree Intervention - Environmental Design:
    • Color Schemes to identify unit
    • Circular Unit Design
    • Camouflage doors (exit signs must remain)
    • Clearly mark patient's room
    • Change Lighting
    • Quiet Room
    • Reality Orientation Board
  • 4th Degree Intervention - Environmental Design:
    • Door Alarms
    • Tracking system
    • Locked Unit
    • Seclusion Room
Lack of
Control

Lack of Control

  • 1st Degree Intervention - Diversional Activities:
    • Aromatherapy
    • Change of Staff
    • Family or Volunteer
    • Familiar Objects/Possesions
    • Group
    • Hobbies
    • Pet Therapy
    • Reading
    • Rocking
    • Movies
    • Social Interaction
    • Walks
    • Orientation/Reorientation to Unit
    • Regular Exercise
    • Musical(group/individual, listening/playing, familiar styles/songs)
    • Purposeful Activities (make bed, clean room, fold towels, etc.)
    • Therapeutic Touch (object textures, physical contact)
  • 1st Degree Intervention - Monitoring Activities:
    • One to One
    • Location Checks
  • 2nd Degree Intervention - Environmental Enhancements:
    • Therapeutic Decor (Aviaries, Aquariums, Plants, etc.)
    • Dark Flooring to create perceived voids in floor
  • 3rd Degree Intervention - Environmental Design:
    • Color Schemes to identify unit
    • Locator Maps
    • Clearly mark patient's room
    • Circular Unit Design
    • Quiet Room
    • Change Lighting
    • Clearly marked signs that can be easily read
    • Camouflage doors (exit signs must remain)
  • 4th Degree Intervention - Environmental Design:
    • Reality Orientation Board
    • Door Alarms
    • Tracking system
    • Locked Unit
    • Seclusion Room
Pacing

Pacing

  • 1st Degree Intervention - Diversional Activities:
    • Aromatherapy
    • Family or Volunteer
    • Familiar Objects/Possesions
    • Group
    • Hobbies
    • Pet Therapy
    • Reading
    • Rocking
    • Movies
    • Social Interaction
    • Walks
    • Orientation/Reorientation to Unit
    • Regular Exercise
    • Musical(group/individual, listening/playing, familiar styles/songs)
    • Purposeful Activities (make bed, clean room, fold towels, etc.)
    • Therapeutic Touch (object textures, physical contact)
  • 1st Degree Intervention - Monitoring Activities:
    • One to One
  • 2nd Degree Intervention - Environmental Enhancements:
    • Therapeutic Decor (Aviaries, Aquariums, Plants, etc.)
    • Soft Door Barriers
    • Soft Door Knobs
    • Dark Flooring to create perceived voids in floor
  • 3rd Degree Intervention - Environmental Design:
    • Color Schemes to identify unit
    • Locator Maps
    • Clearly mark patient's room
    • Circular Unit Design
    • Quiet Room
    • Change Lighting
    • Clearly marked signs that can be easily read
    • Camouflage doors (exit signs must remain)
  • 4th Degree Intervention - Environmental Design:
    • Door Alarms
    • Tracking system
    • Locked Unit
Purposeful
Wandering

Purposeful Wandering

  • 1st Degree Intervention - Diversional Activities:
    • Aromatherapy
    • Family or Volunteer
    • Familiar Objects/Possesions
    • Group
    • Hobbies
    • Pet Therapy
    • Reading
    • Movies
    • Social Interaction
    • Walks
    • Regular Exercise
    • Musical (group/individual, listening/playing, familiar styles/songs)
    • Purposeful Activities (make bed, clean room, fold towels, etc.)
    • Therapeutic Touch (object textures, physical contact)
  • 1st Degree Intervention - Monitoring Activities:
    • One to One
    • Location Checks
  • 2nd Degree Intervention - Environmental Enhancements:
    • Therapeutic Decor (Aviaries, Aquariums, Plants, etc.)
    • Soft Door Barriers
    • Dark Flooring to create perceived voids in floor
  • 3rd Degree Intervention - Environmental Design:
    • Circular Unit Design
    • Camouflage doors (exit signs must remain)
    • Clearly mark Patient's room
    • Change Lighting
    • Quiet Room
    • Reality Orientation Board
  • 4th Degree Intervention - Environmental Design:
    • Door Alarms
    • Tracking system
    • Locked Unit
    • Seclusion Room
Stress

Stress

  • 1st Degree Intervention - Diversional Activities:
    • Aromatherapy
    • Change of Staff
    • Family or Volunteer
    • Familiar Objects/Possesions
    • Group
    • Hobbies
    • Pet Therapy
    • Reading
    • Rocking
    • Movies
    • Social Interaction
    • Walks
    • Orientation/Reorientation to Unit
    • Regular Exercise
    • Musical (group/individual, listening/playing, familiar styles/songs)
    • Purposeful Activities (make bed, clean room, fold towels, etc.)
    • Therapeutic Touch (object textures, physical contact)
  • 1st Degree Intervention - Monitoring Activities:
    • One to One
    • Location Checks
  • 2nd Degree Intervention - Environmental Enhancements:
    • Therapeutic Decor (Aviaries, Aquariums, Plants, etc.)
  • 3rd Degree Intervention - Environmental Design:
    • Color Schemes to identify unit
    • Locator Maps
    • Clearly mark patient's room
    • Circular Unit Design
    • Quiet Room
    • Change Lighting
    • Clearly marked signs that can be easily read
    • Reality Orientation Board
  • 4th Degree Intervention - Environmental Design:
    • Door Alarms
    • Tracking system
Unpurposeful
Wandering

Unpurposeful Wandering

  • 1st Degree Intervention - Diversional Activities:
    • Aromatherapy
    • Family or Volunteer
    • Familiar Objects/Possesions
    • Hobbies
    • Group
    • Reading
    • Pet Therapy
    • Movies
    • Rocking
    • Walks
    • Social Interaction
    • Regular Exercise
    • Orientation/Reorientation to Unit
    • Musical (group/individual, listening/playing, familiar styles/songs)
    • Purposeful Activities (make bed, clean room, fold towels, etc.)
    • Therapeutic Touch (object textures, physical contact)
  • 1st Degree Intervention - Monitoring Activities:
    • One to One
    • Location Checks
  • 2nd Degree Intervention - Environmental Enhancements:
    • Therapeutic Decor (Aviaries, Aquariums, Plants, etc.)
    • Soft Door Barriers
    • Soft Door Knobs
    • Dark Flooring to create perceived voids in floor
  • 3rd Degree Intervention - Environmental Design:
    • Color Schemes to identify unit
    • Locator Maps
    • Clearly mark patient's room
    • Circular Unit Design
    • Reality Orientation Board
    • Change Lighting
    • Quiet Room
    • Clearly marked signs that can be easily read
    • Camouflage doors (exit signs must remain)
  • 4th Degree Intervention - Environmental Design:
    • Door Alarms
    • Tracking system
Verbalizing
Intent to Leave

Verbalizing Intent to Leave

  • 1st Degree Intervention - Diversional Activities:
    • Aromatherapy
    • Family or Volunteer
    • Familiar Objects/Possesions
    • Group
    • Hobbies
    • Pet Therapy
    • Reading
    • Rocking
    • Movies
    • Social Interaction
    • Walks
    • Orientation/Reorientation to Unit
    • Regular Exercise
    • Musical (group/individual, listening/playing, familiar styles/songs)
    • Purposeful Activities (make bed, clean room, fold towels, etc.)
    • Therapeutic Touch (object textures, physical contact)
  • 1st Degree Intervention - Monitoring Activities:
    • One to One
    • Location Checks
  • 2nd Degree Intervention - Environmental Enhancements:
    • Therapeutic Decor (Aviaries, Aquariums, Plants, etc.)
  • 3rd Degree Intervention - Environmental Design:
    • Quiet Room
    • Reality Orientation Board
  • 4th Degree Intervention - Environmental Design:
    • Door Alarms
    • Tracking system
    • Locked Unit
Definitions

Definitions

Anxiety
A feeling of apprehension, uncertainty, and fear without apparent stimulus, and associate with physiological changes(tachycardia, sweating, tremor, etc.).
Confusion
A state of disordered orientation; a disturbance of consciousness in the sense that awareness of time, place, or person is unclear.
Depression
A psychiatric syndrome consisting of dejected mood, psychomotor retardation, insomnia, and weight loss, sometimes associated with guilt feelings and somatic preoccupation often of delusional proportions. Marked by sadness, inactivity, difficulty in thinking and concentration, a significant increase or decrease in appetite and time spent sleeping, feelings of dejection and hopelessness, and sometimes suicidal tendencies. As used by the layman, it ordinarily refers only to the mood element, which would be labeled as dejection, sadness, gloominess, despair, despondency, etc.
Escape
The act of becoming free from surroundings, to avoid a threat, perceived or real.
General Restlessness
Continuously moving for no apparent reason. Inability to remain still, sleepless, fitful, unquiet, agitated, ill at ease, nervous, jittery, jumpy, fidgety, worried, fretful, anxious, hyperactive, never at rest.
Hallucinations/Delusions
Hallucinations - Apparent perceptions of an external object when no such object is present.
Delusions - False personal beliefs based on incorrect inference about external reality and firmly maintained in spite of incontrovertible and obvious proof or evidence to the contrary.
Lack of Control
Inability to restrain oneself from inappropriate activities or thoughts.
Pacing
Walking back and forth with no apparent destination.
Purposeful Wandering
Roaming with a desired location in mind, even if not in reality.
Stress
The sum of the biological reactions to any adverse stimulus, physical, mental, or emotional, internal or external, that tends to disturb the normal state (equilibrium).
Unpurposeful Wandering
To roam about without a fixed course, aim, or goal.
Verbalizing Intent to Leave
Expressing strong longing, desire, or impulse to be in another location that has been experienced or is desired.
Communicating

Communicating

When communicating with patients:
  • Speak clearly
  • Use a calm voice and positive attitude
  • Make visual cues to re-enforce your words
  • Make eye contact
  • Get their attention by motion or touch
  • Look for facial signs of understanding
  • Ask yes or no questions and use short simple phrases