Code 11 is a term used in hospitals and other medical facilities to indicate a patient elopement or escape. It signals staff that a patient has wandered or run away from where they are meant to be and prompts an urgent search and recovery response. Code 11s are initiated when a patient leaves without authorization or notification, posing a potential risk to themselves or others. While reasons for elopements vary, code 11s aim to quickly locate patients and return them to safety.
What Triggers a Code 11?
There are a few common scenarios that will result in a code 11 being called in a hospital:
Elopement of an At-Risk Patient
Patients considered at high risk for wandering such as those with dementia, Alzheimer’s, or other cognitive conditions may attempt to leave the facility unexpectedly. These patients can become confused about their surroundings and try to exit the building seeking familiar settings. Children may also try to run off out of boredom or defiance. Promptly initiating a code 11 is crucial for locating the patient before they injure themselves or become endangered.
Unauthorized Departure
Any patient leaving without hospital approval and against medical advice can prompt a code 11. This includes both inpatients leaving their rooms or treatment areas before being formally discharged and outpatients leaving prematurely from procedures before being cleared by staff. These elopements disrupt care and place patients at unwarranted risk, so the code 11 allows the hospital to promptly get them back for evaluation and care.
Missing or Wandering Patient
A code 11 may be activated if any patient cannot be located or is discovered to be wandering halls or grounds without supervision. This could result from a patient slipping away unnoticed, caregivers becoming distracted, or inaccurate patient tracking. The code 11 summons staff to thoroughly search and safely recover the missing individual.
How Code 11s Work
When it is discovered that a patient elopement or wandering has occurred, the following takes place:
Code 11 Announcement
A “code 11” announcement will be broadcast through the hospital PA system or using wireless communication devices carried by staff. Details like the name of the missing patient and their last known location may be shared.
Lockdown Procedures
The hospital will immediately lock down certain areas to maximize search effectiveness and limit the patient’s movement. Entryways, exits, elevators, and stairwells may be secured.
Organized Search Effort
Available clinical and non-clinical staff will coordinate to efficiently search the premises using a systematic approach. Areas like patient rooms, restrooms, stairwells, chapels, courtyards, and parking areas may all be swiftly checked.
Security Assistance
Security personnel will provide extra support by monitoring building access points, reviewing surveillance footage, and aiding with the search. Local law enforcement may also be contacted for help.
Notification of Loved Ones
For inpatients, the hospital will typically notify family members or authorized caregivers if a code 11 is called for their loved one. They can provide information that may help locate the patient.
Code 11 Search Procedure
When a code 11 is activated, hospital staff follow a specific search procedure for safely and quickly recovering the missing patient. Steps include:
Confirm Elopement
First, nearby staff must validate that the patient cannot be located and has likely wandered or eloped. They will quickly check surrounding rooms, bathrooms, hallways, and other immediate areas to rule out false alarms.
Call Code 11
Once confirmed, an employee will call a “code 11” via the hospital intercom or radio system. They provide key details like name, age, physical description of the patient and any special medical needs.
Lock Down Exits
Staff will immediately secure potential exit points like stairwell doors, elevators, lobby doors, and parking lot gates. This limits escape and simplifies the search zone.
Organize Search Party
Available staff will coordinate to assign search areas methodically. Teams will cover zones like patient floors, the ER, imaging, outpatient areas, cafeterias, chapels, courtyards, etc. Search parties ensure all sections are searched quickly and thoroughly.
Check Surveillance Footage
Security staff will review surveillance cameras near the patient’s last known location and potential exit routes. This can provide clues about potential direction and inform the search.
Question Witnesses
Nearby patients, visitors, and personnel will be asked if they saw the missing individual. First-hand sightings and direction of travel can further direct search efforts.
Search Assigned Zones
Search teams will use a systematic, top-to-bottom approach checking their designated areas. Bathrooms, patient rooms, closets, stairwells, empty rooms, and other spots are inspected.
Follow Safety Protocols
Staff must adhere to protocols like traveling in pairs, bringing radios or phones, and taking precautions if locating a combative patient. Searching safely is a top priority.
Verify Resolution
Once found, at least two staff members must stay with the patient at all times until they are safely returned to the care setting. Searches continue until the code 11 can be officially canceled.
Why Code 11s are Critical
There are important reasons why hospitals institute a specialized code 11 response for wandering and elopement events:
Prevent Harm to the Patient
An escaped patient faces many dangers like injuries from falls or vehicle collisions, side effects of treatment noncompliance, and exposure to temperature extremes. Instituting rapid chase protocols aims to locate them before adverse events occur.
Protect Other Individuals
A disoriented, agitated, or combative patient who flees may also inadvertently jeopardize others’ safety. Safely intercepting them prevents potential assaults, violent acts, or attempts to steal vehicles.
Uphold Legal Obligations
Hospitals have a legal duty to take reasonable precautions against patient escape and to enact policies for timely location and retrieval. Code 11 procedures demonstrate appropriate standards of care.
Maintain Order
An escaped patient disrupts hospital operations and steals staff resources away from other patients. Code 11s allow efficient, coordinated responses to restore normal operations.
Preserve Reputation
Highly publicized cases of patient escape can damage community trust and tarnish a hospital’s standing. Strict code 11 policies portray responsiveness.
Special Considerations in Code 11s
Certain additional factors must be considered when implementing a code 11 response:
Safety Hazards
The search team must be informed of any safety hazards about the missing patient like agitation, violence, infections, fall risk, or IV lines. This allows proper precautions.
Mental Status
Knowing details about the patient’s mental status, like dementia or delirium, provides clues on where they may wander and how to approach them.
Legal Status
If an escaping patient is a threat to themselves or others, security may exercise appropriate restraint and hospitals may need to involve law enforcement.
Media Issues
For high-profile cases, hospitals may need external communications plans and structured coordination with authorities to manage media issues.
Checklist Use
Code 11 responders should use pre-established checklists to ensure all containment, search, documentation, and reporting protocols are followed.
Forensic Evidence
If an escaping patient harms someone, facilities may need to lock down and preserve any areas relevant to forensic analysis.
Code 11 Call Process
The typical workflow for calling a code 11 is:
Discovery of Absence
Staff discover a patient missing from their room, department, or other care area, or see them exiting unauthorized.
Preliminary Search
Nearby personnel quickly check obvious adjacent spots like bathrooms, halls, lobbies, etc. to rule out errors.
Code 11 Activation
If unsuccessful, the staff member calls the emergency code including key ID details, descriptions, and other situational information.
Lockdown Initiation
Security and facilities staff immediately lock access points to contain the search zone.
Notifications Made
Applicable loved ones and law enforcement are informed of the patient escape event.
Search Crew Assembly
Available staff are pulled from regular duties to carry out systematic search procedures per area assignments.
Surveillance Review
Security reviews cameras for sightings and clues to expand or redirect the search as needed.
Resolution
When found, the patient is compassionately retrieved, and the code 11 is canceled. Documentation and debriefs follow.
How Staff Should Respond
When a code 11 is announced, hospital personnel should:
Stop Current Tasks
All non-urgent activity ceases so staff can assist with the search. Patient care continues for those unable to leave rooms.
Secure Areas
Staff lock down and monitor areas under their purview like stations, clinics, pharmacies, supply rooms, offices, etc.
Clear Main Paths
Hallways, stairwells, and circulation paths are kept clear so searchers can move quickly.
Question Visitors
Politely ask any visitors if they have seen the described missing individual and relay any leads.
Join Searches If Able
Available staff should coordinate with leaders to gain search area assignments and retrieval instructions.
Remain Vigilant
All staff should keep eyes open for the missing patient even after returning to regular duties.
Code 11 Documentation
Proper documentation is important for code 11 events. Required information includes:
Patient Identity
Full legal name, age, DOB, physical descriptors, and other identifiers.
Incident Details
Date, time, and location code 11 was activated. Room number, department, etc.
Last Observed
Date, time, and location patient was last seen before incident.
Notifications Made
Account of communication to security, administration, loved ones, law enforcement.
Search Efforts
Areas searched, locked down, and monitored. Surveillance details.
Condition When Found
Mental status, physical state, and any injuries or complaints.
Recovery Information
Exact time and location found. How patient was secured and escorted.
Debrief Notes
Any follow-up prevention recommendations, policy reviews, or liability concerns.
Notifying Loved Ones of Code 11
Best practices for notifying family members or caregivers include:
Identify Contacts
Obtain stat list of patient’s authorized emergency contacts and priority for calls.
Assign Staff
Have clinician like a social worker or case manager make notifications, not security.
Explain Event
Calmly explain that a code 11 has been activated for patient’s unauthorized departure.
Share Response
Explain search efforts underway, containment protocols, and offer frequent updates.
Solicit Information
Ask if they have suggestions on where patient may go or how to approach them.
Express Empathy
Acknowledge any emotions like anxiety or anger. Affirm hospital’s dedication to finding patient.
Provide Closure
Once resolved, inform contact the patient has been located and is safe in care.
Follow Procedures
Fully document details of contact, information shared, and responses according to protocol.
Code 11 Prevention Strategies
Hospitals use many strategies to proactively prevent patient elopements and wanderings that require code 11 activation:
Patient Assessment
Determine escape risk factors during intake like dementia, confusion, impulsivity, and history of wandering.
Secured Units
High elopement risk patients may be assigned to locked units with restricted access like psych floors.
Sitters or Companions
At-risk patients may have assigned staff or family members to provide constant eyes on supervision.
Identification Devices
Wander-prone patients may be given ID wristbands, badges, or tracking devices for quick identification.
Drug Therapies
Medications may be used to reduce agitation, stabilize moods, or control impulses in certain patients.
Facility Safeguards
Strategically placed alarms, fences, patient tracking systems, restricted access zones and surveillance systems.
Routine Checks
Nursing staff perform frequent, mandatory checks even for lower-risk patients.
Patient Engagement
Keeping patients involved in care decisions and activities can reduce boredom and impulsive behaviors.
Conclusion
In summary, a code 11 is a critical hospital emergency response to locate and safely retrieve escaped or wandering patients. It involves carefully coordinated search teams, lockdown procedures, surveillance review, involved loved ones, and proper documentation. Code 11 policies balance patient safety, dignity, and care quality standards. With mindful prevention tactics and swift responses when enacted, hospitals can uphold their duty to protect patients, staff, and the public.
