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Running title Absconding from acute inpatient wards. Five year review of absconding in three acute psychiatric inpatient wards in Australia. Adam Gerace BPsych Hons PhD1,Candice Oster BA Hons PhD1. Krista Mosel BNurs BNg RN1,Deb O Kane MHN MN1,David Ash MBBS FRANZCP Dip Psychotherapy2 3 4. Eimear Muir Cochrane BSc Hons RN Grad Dip Adult Ed MNS Credentialed mental. health nurse PhD1,School of Nursing Midwifery, Faculty of Medicine Nursing and Health Sciences Flinders University of South Australia. Adelaide Australia, School of Medicine Faculty of Health Sciences The University of Adelaide South. Australia Australia, Ramsay Health Care South Australia Mental Health Services Adelaide Australia.
Central Adelaide Local Health Network South Australia Australia. Address for correspondence Adam Gerace School of Nursing Midwifery Flinders. University of South Australia Sturt Road Bedford Park SA 5042 Australia. Email adam gerace flinders edu au Telephone 61 8 8 201 7640 Facsimile 61 8 8276. Absconding where patients under an involuntary mental health order leave hospital without. permission can result in patient harm and emotional and professional implications for. nursing staff However Australian data to drive nursing interventions remains sparse The. purpose of this retrospective study was to investigate absconding in three acute care wards. from January 2006 June 2010 in order to determine absconding rates compare patients who. did and did not abscond and to examine incidents The absconding rate was 17 22 incidents. per 100 involuntary admissions 12 09 of patients with no significant change over time. Being male young diagnosed with a schizophrenia or substance use disorder and having a. longer hospital stay were predictive of absconding Aboriginal and Torres Strait Islander. patients had higher odds of absconding than Caucasian Australians Over 25 of absconding. patients did so multiple times Patients absconded early in admission More incidents. occurred earlier in the year during summer and autumn later in the week and few incidents. occurred early in the morning Almost 60 of incidents lasted 24 hours Formulation of. prospective interventions considering population demographic factors and person specific. concerns are required for evidence based nursing management of the risks of absconding and. effective incident handling when they do occur,Key words absconding acute care inpatients. Introduction, Absconding from acute care inpatient psychiatric wards can have serious. consequences A study in England and Wales over a 10 year period found that a quarter of. inpatient suicides involved a patient who had absconded Hunt et al 2010 Australian. studies have reported that over a 21 year period 36 of patients who had committed suicide. did so after absconding Shah Ganesvaran 1997 2000 and that in a 10 year study of. patients admitted to a medical facility for self poisoning four of 24 who had absconded. during an admission subsequently died within two years Reith et al 2004 Other serious. outcomes include self harm and violence harm to others Bowers et al 1999a Even in cases. where there are no serious outcomes and patients return patient treatment is interrupted. Nurses experience negative emotional e g fear and indeed professional outcomes e g. blame by colleagues and management punitive measures when patients abscond Clark et. al 1999 Nursing staff and other personnel such as police are also then involved in time. consuming paperwork and procedures that detract from nursing care of other patients on the. ward Martin Thomas 2014 Muir Cochrane et al 2012, Given potential deleterious outcomes it is important to have an in depth. understanding of absconding This will inform interventions to reduce rates of absconding. from inpatient services To date few recent nursing focused interventions and none. Australian have been reported see Bowers et al 2003 2005 nor validated risk assessment. tools published Although nurses have been found to accurately assess risk Lewis Webster. 2004 this largely takes the form of informal assessment Clark et al 1999 Indeed even. when risk assessment measures are used in the clinical setting absconding risk is often not. included Gerace et al 2013a Reliable and valid data should drive any risk profile. formulation and evidenced based nursing interventions to reduce absconding Mosel et al. 2010a Fisher 2003, Two literature reviews together covering the period 1950 to 2008 Bowers et al. 1998 Muir Cochrane Mosel 2008 indicate characteristics of absconders being young. male single from disadvantaged groups involuntarily hospitalized or from police court. referral and with a diagnosis of schizophrenia Absconding is likely to occur in an earlier. part of admission and in warmer seasons with mixed findings regarding specific days times. Methodological issues were identified by the reviews including whether patients not under a. mental health treatment order who leave without telling staff should be included in. absconding rates For the purposes of the present study absconding was defined as a patient. on an involuntary order under mental health legislation leaving the ward without permission. Unfortunately Australian literature is relatively sparse and several years old In a 6 month. study on an acute psychiatric ward Meehan et al 1999 13 1 of patients absconded at least. once with 31 4 of these patients doing so repeatedly Absconding patients were. predominantly male under 40 years of age with diagnoses of schizophrenia or acute. psychosis and admitted under mental health legislation Almost 50 of incidents occurred. within a week of admission and over a third occurred in the morning. In a 12 month study of aggression and absconding incidents in 11 mental health. wards Carr et al 2008 reported an estimated 15 7 of admissions involved an absconding. incident Multivariate analysis revealed that older 55 patients were less likely to abscond. and those with a diagnosis of a drug and alcohol disorder more likely to abscond While. schizophrenia or related conditions more likely bipolar disorder more likely and. depression or an adjustment disorder both less likely were associated with absconding they. were not statistically significant when other variables were taken into account In a recent. study investigating absconding from acute care wards over a 12 month period 10 21 of. patients absconded at least once gender was not associated with absconding and while. almost 70 of patients who absconded had a diagnosis of schizophrenia this was not. significant when compared to the total hospital population with this disorder Mosel et al. While these Australian studies provide a local perspective they are hampered by. failure to separate characteristics of absconding patients from other patients when absconding. is not the main focus Reith et al 2004 Shah Ganesvaran 1997 2000 short data. collection periods Meehan et al 1999 Mosel et al 2010a and the lack of a non absconding. comparison group Meehan et al 1999 In depth examination utilizing multiple methods of. rate calculation and clear description of which patients and incidents are included is needed. to inform prediction and nurse management Bowers et al 1998 This aids in benchmarking. for services and takes account of changes over time in factors affecting rates such as service. configuration patient demographics and ward structures e g locked doors that may not be. picked up with shorter data collection periods Meehan et al 2007 In addition providing. Australian data is likely to take account of factors more useful from a local perspective e g. presence of an Aboriginal and Torres Strait Islander ATSI population. The potential for serious outcomes and the lack of adequate recent analysis in the. Australian context indicates the need for a more detailed understanding of absconding from. acute care wards This is particularly important for nurses who are responsible for much of. the hands on regular care of patients and for providing information to consultants and. doctors to guide patient treatment Bishop Ford Bruins 2003 as well as implementing. interventions such as increased observation as needed Clark et al 1999 The purpose of this. study was to determine rates of absconding compare characteristics of patients who did and. did not abscond from the wards and to examine the characteristics of absconding incidents. This information will inform the formulation of interventions to reduce or prevent. absconding,Materials and methods, The study was retrospective and comparative providing an analysis of absconding.
between January 2006 and June 2010 across three acute care wards. Data on all inpatients who stayed on the included wards during the 54 month period. and absconding incidents by involuntary hospitalized persons were extracted from the. inpatient discharge database maintained by the institution Staff managing the database. system extracted the data and provided it to the researchers in deidentified form This. database contains patient identification numbers admission and discharge dates ward. changes demographic details of patients e g sex age and primary diagnosis classified. using the International Statistical Classification of Diseases and Related Health Problems. 10th revision ICD 10 For absconding incidents patient identification numbers. involuntary hospitalization status at the time the patient absconded e g 3 day involuntary. hospitalization order 21 day involuntary hospitalization order absconding date time and. return date time and the ward from which the patient absconded are recorded Voluntary. patients who left without telling staff were inconsistently recorded in the electronic database. from which data was drawn this data was not included in the study Details of how patients. returned were returned to hospital and any incidents that occurred while they were away were. not available to the researchers, Data was imported from Microsoft Excel spreadsheets to IBM SPSS Statistics for. Windows version 22 IBM Corp Armonk NY USA and examined for missing values and. outliers e g a particularly long admission Clarification of such data with systems staff e g. to verify that admission durations were correct was undertaken. A subset of the data a 12 month period from 2006 2007 has been reported. previously Mosel et al 2010a The study was approved by the University research ethics. committee and hospital senior managers, Setting and procedures following an abscond incident. Three acute psychiatric wards were included The wards provided all general adult. acute care at an Australian metropolitan psychiatric hospital with two wards providing care. for metropolitan patients and one ward providing services for rural and remote patients The. ward providing care for rural and remote patients and one of the wards providing care to. metropolitan patients operated during the entire data collection period 54 months while the. other ward was closed in October 2006 10 months due to a relocation of services All wards. have been included to provide a complete data set of absconding in the hospital over the 54. month period Wards had high occupancy 95 or higher over the data collection period. and between 18 and 23 beds, Although some procedures differed between wards and over time wards were open. from approximately 6am 11pm Doors were locked at night and for short time periods if there. was a safety issue Strategies for reducing absconding focused on increased visual. observations and providing 1 1 observation based on risk assessment rather than other. methods such as transferral to a secure ward Wards were staffed by mental health nurses. registered nurses some of whom are completing mental health studies and enrolled nurses. Specific training was not provided on prevention of absconding but training was. provided on risk assessment and several training packages existed regarding patient. engagement According to hospital procedure when a patient is missing from a ward a search. of the patient s room ward and grounds is undertaken and other patients may be interviewed. Senior clinicians and coordinators are notified within 30 minutes and next of kin contacted. Police are notified and depending on level of judged risk the patient is deemed as on. unapproved leave low risk or a missing person moderate or serious risk on a Notification. of Missing Person Unapproved Leave form When patients return to the ward strategies to. minimise further absconding include increased observations changes in medication. discussion with the patient regarding their absconding and treatment orders and other. methods based on specific need e g restricting access to bank cards. Data analysis, Rates of absconding were calculated per 100 admissions number of incidents or. patients absconding per month divided by number of involuntary hospitalized patients in the. ward per month multiplied by 100 Bowers 2000 Multiple admissions for one person were. treated separately e g a patient with multiple separate admissions would be counted for each. of those admissions in the numerator and or denominator. Data were analysed using IBM SPSS Statistics for Windows version 22 IBM Corp. Armonk NY USA Binary logistic regression was used to analyse predictors of absconding. Descriptive statistics two sample t tests Pearson s 2 both tests of independence and. goodness of fit Kruskal Wallis and Mann Whitney tests were used to analyse characteristics. failure to separate characteristics of absconding patients from other patients when absconding is not the main focus Reith et al 2004 Shah amp Ganesvaran 1997 2000 short data collection periods Meehan et al 1999 Mosel et al 2010a and the lack of a non absconding comparison group Meehan et al 1999 In depth examination utilizing multiple methods of rate calculation and

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