When a patient goes absent without leave (AWOL) procedure

Contents

1 Aim

The aim of this document is to provide service specific guidance for staff who work in the forensic service when dealing with an AWOL situation to ensure effective management and reporting of the incident, meeting the requirements of the Care Quality Commission (CQC).

2 Scope

This document applies specifically to the forensic service and provides procedural guidance for use of staff working in this service including agency, bank and students.

3 Link to overarching policy, and or procedure

This procedure will run in conjunction with the trust policy for patients missing or absent without leave (AWOL) policy.

4 Procedure or implementation

4.1 Definition

The term absent without leave (AWOL) in the forensic service is defined by the NHS secure commissioners as “any situation where patients are absent without agreement or planned leave or have not returned from leave”.

4.2 Action to be taken if a patient goes AWOL whilst an inpatient in the forensic service

• Staff must immediately notify the nurse in charge.
• Organise an immediate search of the surrounding area.
• Notify switchboard of the AWOL.
• If the search is unsuccessful, notify the police immediately and complete a missing person (police form), making clear the patient’s legal status, multi-agency public protection (MAPPA) status and identifying all risks and management plans.
• Notify the responsible clinician and management team during working hours.
• Out of hours, contact the on-call consultant and the manager who can escalate the situation appropriately within the on-call structure within the trust.
• Notify switchboard as they may receive calls with regard to the missing person.
• Notify the patient’s next of kin as the patient may make contact with them.
• Comprehensively record all action taken into the patient’s electronic clinical record, SystmOne.
• Register the patient as AWOL on SystmOne.
• Complete an electronic incident report form (IR1) via the trust’s safeguarding incident reporting system.
• In the event that the patient does not return to the ward by midnight on the first day of absence complete and email the CQC AWOL notification form to the CQC. Then send the original to the service manager or matron or MHA office.
• Notify the Mental Health Act office of the AWOL.
• Complete the required, this is needed for any AWOL incident going past midnight (do not complete on-line print and send to the relevant areas, scan and save to SystmOne)

4.3 Action to be taken if there is an identified risk to person or persons in the event of a patient going AWOL

• Staff must refer to the patient profile sheet which will detail identified risks. This is found in the front of the patient file, as per business continuity planning requirements.
• Staff will need to use the above information to inform anyone identified in the patient’s risk assessment and risk management plan of the fact the patient has left the unit unsupervised.
• Identify any victim issues that need to be taken into account and liaise with police as appropriate.
• Determine if the patient is subject to MAPPA and if so notify them.
• Any child or adult safeguarding issues notify the appropriate social service or duty social worker outside of normal working hours.
• Notify switchboard who may receive any calls about the missing person.

4.4 Action to take if the patient has not returned to the unit by midnight on the first day of absence

• Complete part 1 of the CQC AWOL notification form and send immediately to the head of service and modern matron ensuring a copy is also sent to the Mental Health Act office for submission to the CQC.
• Notify NHS England of the incident.

4.5 Action to be taken when the patient returns

• Complete a full search upon return to the unit
• Complete alcohol and drug testing if clinically indicated.
• It is the responsibility of the nurse or clinician in charge to inform everybody previously notified of the patient’s absence of their return. This includes out of hours the bronze, silver, gold command.
• Nurse in charge should only contact the on-call doctor outside of normal working hours about the return of an absent patient if there are concerns about the patients’ mental state or physical presentation and the medical attendance is needed.
• Suspend any further planned section 17 leave until a review can be undertaken by the responsible clinician and multi disciplinary team.
• Modern matron to instigate a serious incident review.
• When a patient who absconds has been reported to the Care Quality Commission and returns, part two of the CQC AWOL notification form is to be completed and emailed to the CQC and a copy to MHA Office to them (see appendix A).

5 Appendices

Please see forensic services manual webpage for appendices attached to this procedure.

• Appendix A Admission to inpatient learning disability forensic services procedure

Document control

• Version: 2.
• Unique reference number: 530.
• Approved by: Clinical policies review and approval group.
• Date approved: 2 November 2021.
• Name of originator or author: Forensic outreach liaison team manager.
• Name of responsible individual: Executive director of nursing and AHPs.
• Date issued: 5 January 2022.
• Review date: January 2025.
• Target audience: For all staff working in the forensic service.
• Description of change: Minor amendments.

Page last reviewed: May 21, 2024
Next review due: May 21, 2025