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Run: Patient Elopement Risk Assessment

Patient Elopement Risk Assessment template for behavioral health and inpatient settings. Document mobility, mental status, exit-seeking behavior, history, an...

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Assessment Setup and Scope

Assessment completed for the correct patient and current encounter critical (required)

Verify patient identity and that the assessment applies to the present admission, visit, or shift reassessment.

Yes No N/A

Reason for assessment documented

Select the trigger for the assessment.

Relevant chart review completed before assessment

Document which sources were reviewed before determining risk.

Yes No N/A

Assessment time documented critical (required)

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.

Yes No N/A

Patient demonstrates purposeful exit-seeking or wandering critical (required)

Mark yes if the patient repeatedly approaches doors, asks to leave, follows others out, or wanders toward exits.

Yes No N/A

Access to exits or unsecured areas observed critical (required)

Determine whether the patient can reach doors, stairwells, elevators, or other exit routes without adequate supervision.

Yes No N/A

Need for supervision during ambulation documented

Select the level of supervision needed when the patient is mobile.

Mental Status and Behavioral Risk

Orientation assessed critical (required)

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 critical (required)

Identify behaviors that may lead to sudden departure or unsafe movement toward exits.

Yes No N/A

Psychosis, paranoia, hallucinations, or severe anxiety affecting safety critical (required)

Document whether mental status symptoms increase the likelihood of elopement or nonadherence.

Yes No N/A

Patient verbalizes desire to leave or refuses treatment critical (required)

Capture explicit statements or actions indicating intent to leave against advice or before safe discharge.

Yes No N/A

Elopement History and Current Precautions

Prior elopement attempt or successful elopement history critical (required)

Document any known history of leaving care areas without authorization.

Yes No N/A

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 critical (required)

Document whether the current precaution level matches the assessed risk.

Rationale for placing, continuing, or removing precautions documented critical (required)

Provide the clinical rationale supporting the precaution decision.

Communication, Monitoring, and Follow-Up

Provider or charge nurse notified of high-risk findings critical (required)

Confirm escalation of significant elopement risk to the appropriate clinician or leader.

Yes No N/A

Care team informed of current elopement precautions

Verify that nursing, behavioral health staff, and other relevant team members are aware of the precautions.

Yes No N/A

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 critical (required)

Confirm staff know what to do if the patient attempts to leave or is missing from the unit.

Yes No N/A

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