Elopement Prevention
Complete per assessment schedule.
- Industry: Healthcare
- Frequency: Per shift / As indicated
- Estimated Time: 10-15 minutes
- Role: Nurse
- Total Items: 33
- Compliance: CMS, State Regulations
Risk Assessment
Assess elopement risk.
- Elopement risk identified?
- Wander guard in place if needed?
- ID bracelet on patient?
Prevention Measures
Verify prevention measures.
- Door alarms functioning?
- Patient location known?
- Staff aware of risk?
Pre-Assessment Information
Initial assessment documentation and patient/facility identification
- Assessor Name / Credentials
- Assessment Date
- Department / Unit
- Assessment Type (Routine/Annual/Complaint)
- Previous assessment findings reviewed?
Infection Prevention & Control
Verify infection control practices per CDC and Joint Commission standards
- Hand hygiene compliance observed?
- Appropriate PPE available and properly used?
- Isolation precautions properly implemented?
- Sharps containers available and not overfilled?
- High-touch surfaces properly disinfected?
Patient Safety & Identification
Verify patient safety protocols and identification procedures
- Two patient identifiers used before procedures?
- Fall risk assessment completed?
- Call light within patient reach?
- Bed in lowest position with brakes locked?
Medication Safety & Management
Verify medication handling and administration practices
- Medications stored securely and at proper temperature?
- Controlled substances properly secured and counted?
- No expired medications in stock?
- High-alert medications properly labeled?
Environment of Care & Safety
Verify facility environment meets safety standards
- Fire exits clear and unobstructed?
- Emergency equipment functional and accessible?
- Spill kits available and stocked?
- Electrical cords and outlets in safe condition?
Documentation & Regulatory Compliance
Complete assessment documentation and ensure regulatory compliance
- All findings documented with evidence?
- Corrective actions assigned with timeline?
- Staff education provided on identified issues?
- Assessor Signature
- Additional Observations
Related Healthcare Checklists
- Clinical Alarm Management
- Specimen Collection Safety
- Blood Transfusion Safety Checklist
- Dialysis Unit Safety Checklist
- Daily Clinic Opening Checklist
- Clinic Closing Procedures
- Exam Room Turnover
- Medical Supply Check