Patient Elopement Risk Assessment

Behavioral health inspection template to document mobility, mental status, behaviors, and elopement history, then assign or remove elopement precautions with rationale.

Assessment Setup and Scope

• Assessment completed for the correct patient and current encounter
  Verify patient identity and that the assessment applies to the present admission, visit, or shift reassessment.
• Reason for assessment documented
  Select the trigger for the assessment.
• Relevant chart review completed before assessment
  Document which sources were reviewed before determining risk.
• Assessment time documented
  Record when the risk assessment was completed.

Mobility and Exit-Seeking Factors

• Ambulation status documented
  Describe how the patient's mobility affects elopement risk.
• Gait or mobility limitations assessed
  Identify whether pain, weakness, unsteady gait, or other limitations reduce or increase elopement risk.
• Patient demonstrates purposeful exit-seeking or wandering
  Mark yes if the patient repeatedly approaches doors, asks to leave, follows others out, or wanders toward exits.
• Access to exits or unsecured areas observed
  Determine whether the patient can reach doors, stairwells, elevators, or other exit routes without adequate supervision.
• Need for supervision during ambulation documented
  Select the level of supervision needed when the patient is mobile.

Mental Status and Behavioral Risk

• Orientation assessed
  Document the patient's current level of orientation and awareness.
• Judgment and insight support safe boundaries
  Rate the patient's ability to understand restrictions and follow directions.
• Impulsivity, agitation, or restlessness present
  Identify behaviors that may lead to sudden departure or unsafe movement toward exits.
• Psychosis, paranoia, hallucinations, or severe anxiety affecting safety
  Document whether mental status symptoms increase the likelihood of elopement or nonadherence.
• Patient verbalizes desire to leave or refuses treatment
  Capture explicit statements or actions indicating intent to leave against advice or before safe discharge.

Elopement History and Current Precautions

• Prior elopement attempt or successful elopement history
  Document any known history of leaving care areas without authorization.
• Number of prior elopement events documented
  Enter the number of prior elopement attempts or incidents if known.
• Current elopement precautions in place
  Select all precautions currently ordered or implemented.
• Precautions remain appropriate for current risk level
  Document whether the current precaution level matches the assessed risk.
• Rationale for placing, continuing, or removing precautions documented
  Provide the clinical rationale supporting the precaution decision.

Communication, Monitoring, and Follow-Up

• Provider or charge nurse notified of high-risk findings
  Confirm escalation of significant elopement risk to the appropriate clinician or leader.
• Care team informed of current elopement precautions
  Verify that nursing, behavioral health staff, and other relevant team members are aware of the precautions.
• Monitoring frequency documented
  Select the monitoring frequency assigned based on risk.
• Follow-up plan documented for reassessment
  Document when the next reassessment will occur or what event should trigger reassessment.
• Escalation or emergency response plan reviewed
  Confirm staff know what to do if the patient attempts to leave or is missing from the unit.