Patient disappearance, namely the primary general causes of wandering and unauthorized leave, and the role of risk assessment in preventing these

Abstract

Disappearance of patients can lead to accidents, falls, injuries, or getting lost, which can even endanger the
patient's life. Therefore, the prevention of such events is an important problem and challenge to be solved.
The two largest groups of patients affected by patient disappearances are elderly patients with dementia and
psychiatric patients, who we deal with in our announcement.
The typical form of patients' disappearance regarding dementia is called wandering within the literature.
It can be sharply distinguished from cases where psychiatric patients leave the medical institution unauthorized with a definite goal, in many cases in a clear state of consciousness. Wandering and leaving unauthorized are denoted together in this paper by the concept of patient disappearance.
The aim of our study is to present the general reasons for disappearance, namely wandering or unauthorized leave of patients receiving inpatient care, and the possible actions that can be taken to prevent them,
based on the analysis of the data received by the national NEVES (Unexpected Events) reporting system.
The reported data were entered into the national database in the context of voluntary and anonymous data
provision. In this study we processed the data of 133 adults who disappeared. In the reported cases, 75.2%
(n=100) of those affected were men, and 24.8% (n=33) were women. Most reports (73.7%) were from patients
aged 20–49. Among the factors contributing to disappearance, psychological illness was mentioned in the largest proportion (79.7%). In 62.4% of the reported cases, this was the first disappearance, while in 17.3% of the cases, this had already happened before. 46.8% of the inpatients (n=124) among whom the disappearance event was reported were regularly visited. 75.9% of the data were reported from active wards, while 19.5% of the reports were from rehabilitation wards and 1.5% from nursing/chronic wards. The other category (3.0%) included case reports from addictionology, adult psychiatry, and unknown locations. According to the professional breakdown, the largest proportion of reports came from psychiatric departments (92.5%). There is no noteworthy difference in the type of department providing patient care (closed: 45.9%; open: 49.6%). Based on the reports, the patient care at the time of the disappearance was typically carried out with the usual number of care providers (91.7%). According to the reported data within the NEVES reporting system the nursing staff checked the missing patients every 15–60 minutes in 66.9% of cases, and every 1–3 hours in 23.3% of cases.
90 patients (67.7%) were found on the day of disappearance, in 6 cases (4.5%) the patient was found the
next day, in one case (0.8%) it took a month to find the patient. In one case, the patient was found (0.8%), but it was not recorded on the data sheet when. In 35 cases (26.3%), the patient could not be found until the report was sent. Mild injury occurred in 3.1%, moderate injury in 4.1%, severe injury in one case (1.0%).
As a result of the causal research, we formed 10 groups of general causes leading to disappearance,
these are: deficiencies in the regulation; employees do not follow the rules; lack of risk assessment; inadequate risk assessment; lack of application of prevention tools/procedures; use of an inappropriate prevention method; inadequate operation of the concierge service; inadequate care environment; communication gaps; the knowledge/experience gained from previous events is not used.
In our paper, we present what concrete measures can help solve the problem for each cause.