How Code Purple Came to Be...

Code Purple Is the hospitals standardized response when an adult patient is reported missing, is not competent or a physician deems them medically unsafe to leave.

Objectives At the completion of this section you will be able to: Determine whether a patient is at risk for wandering or elopement. Consider and implement (as appropriate) interventions to reduce the risk of elopement. Take next steps to activate a Code Purple when an adult patient is discovered missing. Caregivers (All Staff) responsibilities for assisting in Code Purple response.

“Oh No! Where is my patient?” Evolution of Procedures Over Time “30 seconds to Media” Issaquah Urinal (capacity) Ballard ARS (crossing county lines) California (patient found in stairwell)

Risk Factors Things to consider when evaluating a patient for an elopement risk. Is there a known risk for wandering or elopement (e.g., gave verbal indication, made prior attempts)? Does the patient have capacity to decide to leave against medical advice (ability to understand the affects of his/her decisions)? Is the patient in danger of harming him/herself or others? Is there a current medical hold on the patient?

Interventions to Reduce the Risk of Elopement Place patient close to the nursing station. Remove the patient’s clothes and shoes from the room (so patient won’t be tempted to dress and leave). Alert all staff on unit to remain aware of the patient’s location. Put the patient in a purple gown obtained via the linen department for ease of visibility. Purple gowns can be ordered through central supply. Consider taking a picture of the patient for identification. (Ask for assistance from Security Services if camera is needed.) Remember a Code Gray may turn into your next Code Purple.

How to Activate a (possible) Code Purple Dial 3000 for First Hill, Cherry Hill, Ballard, Issaquah, and ACC’s Dial 5911 for Edmonds Announce possible Code Purple Give your name Provide specific location (campus, floor and room # or address) The Administrative Nursing Supervisor, Security Services, and the Safety Team will respond to help staff evaluate the situation and take appropriate actions.

Response Assessments Evaluating Risk Factors Picture/description Known risk for wandering/elopement Capacity to leave AMA Danger of harm Medical Hold Picture/description Video surveillance How long has patient been gone? Is the patient a smoker/drug use? Visitors come?

Additional Code Purple Responses Upon hearing Code Purple paged overhead, all staff reviews the information on the Swedish Online home page or via 386-NEWS, searches their immediate department area for the missing patient, and continues to remain alert until the Code Purple is cleared by overhead page. Normal Intranet Online View: View once Code Purple Activated:

Additional Code Purple Responses If the patient is located, call ext. 3000 and attempt to maintain visual contact with the patient. A search of public areas within the hospital is divided among available staff such as Environmental Services, Engineering, and Central Dispatch & Transport/ Transportation staff.

If Patient is Found Mitigate!! Purple gown/take the clothes Get a photo Place by nursing station Obtain a “sitter” Security/unit awareness of risk for elopement FYI Note in electronic medical record Medical intervention (e.g., medications, electrolytes, restraints?) Attend to patient’s health and mental status Service Recovery for patient/family Contact with patient (healthcare agreement)

Moment of Truth Patient is NOT found Patient is on medical hold Patient is threat to self/others Patient does not have CAPACITY to leave AMA YOU MUST FIND THE PATIENT!!! Yes, and you’ll be the media spokesperson!

External Notification Alert Administrator On-Call/Senior Leadership Alert Risk Management/Legal Call 911 Public Transit Taxis Alert Public Information Officer (PIO) Script ready for the media Spokesperson Imploring public’s assistance Assign Family Contact Contact EAP

List of useful hyperlinks Missing Adult Patient: Code Purple Code Purple Flow Chart Code Purple Checklist Leaving Against Medical Advice Healthcare Agreement HCA Sample

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