1. Module 5 – Tobacco
Elopement
Patient Valuables

2. Purpose This module comprises three topics namely:
Tobacco/Smoke Free Environment
Elopement
Patient Valuables
Verbalize the importance of employees enforcing the facility tobacco/smoke free environment.
Distinguish between Code Gray from Code Green and the responsibilities when a patient eloped
Identify responsibilities and proper procedure when releasing patient valuables

3. Tobacco/Smoke-Free Environment

4. Smoke /Tobacco Free Campus
Smoking is proven to be the nations leading preventable cause of death according to Centers for Disease Control [CDC] 2011.
Consistent with Community Hospital of San Bernardino’s health care mission, creating a smoke-free environment demonstrates the concern the welfare patients, staff and visitors.

5. Smoke /Tobacco Free Campus
Tobacco dependence
Addictive
Extremely difficult to treat
Relapsing disease
May lead to numerous health concerns
Community Hospital of San Bernardino is committed in supporting patients and employees in their efforts to become tobacco free.

6. Smoke /Tobacco Free Campus
There is no smoking within any enclosed building or facility as well as any out door areas of the CHSB Campus:
Cafeteria
Hospital owned vehicles
Lounges
Main Buildings
Offices
Outdoor areas (surrounding the premise)
Parking lots/structure
Personal vehicles (while on the hospital property)
Private offices
Restrooms
Roofs
Stairwells
Trailers

7. Is there an exception? Behavioral Health Services (BHS)
Neurological Care Unit (NCU) adult residents
ONLY IN THEIR DESIGNATED AREAS

8. Who does the Smoke/Tobacco Free Campus include?
Employees
Volunteers
Medical Staff
Visitors
Vendors
Students
Contractors
Patients

9. What’s the Patient to do?
Patients and visitors will be advised of the policy prior to arrival whenever possible.
If necessary, obtain orders from the patients physician for alternative smoking/tobacco cessation therapies while in the facility for those who smoke or use tobacco products.
All in-patients will be assessed and offered referral for smoking cessation programs upon discharge.
Hospitalized patients can not leave their nursing units for the purpose of smoking.

10. Safety Risk Concern about smoking in the room
Search the room
Contact Risk Management
Determination for discontinuation of care
Relinquish all smoking related materials if patient remains non- compliant and return such items upon discharge.

11. Enforcement of this policy is everybody’s responsibility !!
Policy Adherence
Enforcement of this policy is everybody’s responsibility !!

12. Enforcement of Policy
All employees, medical staff, and volunteers shall politely remind anyone who is smoking about the SMOKE/TOBACCO FREE CAMPUS policy.
Focus the message on the importance of a smoke free environment.
Any visitors who are non-compliant will be asked to leave the campus.

13. Violation Employee Patients or visitors
Report to appropriate manager/supervisor/
Security can issue a citation
Subject to disciplinary procedures
Patients or visitors
Notify security if patient/visitor becomes angry and violent.
Attending physician and departmental manger/ supervisor/designee shall be notified for assistance.

14. Procedures for Actions of Enforcement
Position Responsible
Actions
All staff
Reminds patient of smoke-free policy and requested to extinguish and/or remove cigarettes.
Directs or escorts patient back to his or her hospital room.
Informs the physician team, including the attending physician.
Notifies the Patient Safety/Risk Management at 1256.
Notifies Security, if patient refuses to cooperate.
Documents all actions in the patient’s chart.

15. Procedures for Actions of Enforcement
Position Responsible
Actions
Physician
Visits with patient to advise and warn of possible discontinuation of care if behavior in violation of policy continues.
Documents all actions in the patient’s chart.
Security
If contacted, asks patient to return to room.
If patient is uncooperative, notifies charge nurse and asks for assistance.
Visitors may be restricted if contributing to the problem.

16. Procedures for Actions of Enforcement
Position Responsible
Actions
Cardiopulmonary Services
Visits the patient, offering a bedside session for smoking cessation, smoking urge management and/or smoking cessation medication information.
Discusses smoke free policy and boundaries, reiterates potential consequences of smoking in the facility.
Documents all actions in the patient’s chart.

17. Elopement

18. Introduction
It is the policy of CHSB to provide a reasonable search, pursuit, communication and documentation in the event a patient has left the premises on elopement.

19. Definition of Terms Elopement AWOL (Absent Without Leave)
Also known as AWOL
AWOL (Absent Without Leave)
Patient has left unit and/or facility without discharge and without notification of hospital staff, or has not returned from a designated pass at the ordered time

20. It is the responsibility of ALL clinical staff to follow the established guidelines in the event a patient has eloped

21. Procedure to Follow When a Patient Eloped
Staff is to make an immediate search of the department. Staff will not pursue patients beyond hospital
Notify Manager/Senior Director and House Supervisor
Notify Security Officer and give description of patient
PSO will search hospital
PSO will check the outside grounds and report back to the nursing staff
After all efforts have been exhausted and patient is not located, the patient’s representative will be contacted and asked to return the call if the patient arrives home

22. Procedure to Follow When a Patient Eloped
Notify the local police department if patient condition indicates
Prepare to give a physical description
Medical information pertinent to the immediate safety of the patient should be provided
Notify attending physician
Document patient’s behavior prior to AWOL, calls placed to physician, family and information regarding the patient’s whereabouts and police report number if police is notified

23. Procedure to Follow When a Patient Eloped
If patient is found, notify department manager, House Supervisor, physician, Security Officer, family and police if they were called and not instrumental in finding the patient first.
If the patient returns voluntarily, do the following:
Assess the patient
Consider toxicology if there is a reason to believe that patient used mind-altering substances. Obtain orders as indicated for toxicology to screen for substances
Conduct a search for contraband articles
Notify attending physician of patient's return
Document patient’s return and condition

24. Procedure to Follow When a Patient Eloped
If the patient does not return after two (2) hour, contact the patient’s attending physician and request an order for discharge against medical advice and follow discharge procedure
For patient's in Education Department, please refer to the Patient Disposition policy

25. Dial extension 1000 if your patient eloped CODE GREEN is called when a patient eloped

26. Dial extension 1000 if your patient is combative CODE GRAY is called when a patient is combative

27. If in doubt or have questions regarding patient who eloped, contact your house supervisor for assistance

28. Patient Valuables

29. Introduction
The responsibility for safeguarding patient valuables is shared by the hospital through the Admitting Department/BHS (for patients admitted to that unit), Security Officer and the patient or authorized representative.
It is recommended that valuable property either be deposited in the hospital’s safe at the time of admission or, preferably, be left at home or in the custody of a family member or trustworthy friend or in some other safe place.

30. ALL patient valuables transactions shall require two (2) employees in attendance, one of which shall be a Security Officer.

31. Responsibilities
Admitting/BHS or other departments authorized to receive valuables
Receives, verifies, records and secures patient valuables in collaboration with Security Officer in the main or BHS valuable safe
Releases patient valuables in collaboration with Security Officer
Upon release, returns valuables to the patient only and obtains patient’s signature that all valuables have been returned
If valuables are to be released to someone other than the patient, responsibility is transferred to Risk Management from Admitting/BHS staff

32. Responsibilities Public Safety
Verifies and secures patient valuables in collaboration with Admitting/BHS staff or other staff where patient is admitted
Ensures that contraband items are either secure or released to law enforcement per policy
Provides audit of access to Patient Valuables Sage via security access and CCTV (Closed Circuit TV) systems

33. Responsibilities Cashier
Provides release of valuables to patients and other authorized person
May accept valuables for safekeeping

34. Responsibilities Risk Manager/Patient Relations
Performs audit of patient valuables process to ensure compliance with California Civil Code
Manages claims alleging loss of patient property and disposition of unclaimed property
Authorizes valuables to be released in the event the patient is deceased, incapacitated or lacks appropriate identification

35. Responsibilities Communication/PBX
Controls issuance of Main Safe Key by maintaining log of key issuance and retrieval including individuals involved

36. Procedure for Keeping Patient Valuables
Initiating a call for Valuables Lock-Up
Nursing Unit to call operator for Security Officer for valuables lock-up
Nursing to advise Admitting Registration for valuables lock-up and to meet Security Officer in unit
Admitting Clerk and Security Officer to meet in nursing department to receive, document and secure patient valuables in the presence of the patient
The descriptions of all items placed in the envelop will be specific and clearly itemized on the receipt as to the appearance and number, but no value will be assigned for any items except money
For amount in excess of $ the amount shall be verified by 3 hospital employees

37. Procedure for Keeping Patient Valuables
The item description will be witnessed and signed for by the Security Officer and the Admitting employee authorized to receive valuables
The patient’s signature will be obtained at this time verifying content of the sealed valuables envelope and a copy of the form given to the patient
The Security Officer and Admitting Clerk will proceed together to the PBX office to obtain the safe key after signing the key log for the main safe and then continue to the safe location. BHS staff to proceed with department safe box

38. Procedure for Release of Valuables
If the patient property transaction is to release valuables, the following process will be followed:
The nursing department to call operator for Security Officer for release of valuables and call Admitting to advise of the pending release
Operator will advise Admitting and department staff for estimated time to allow all parties to meet in a timely manner for the release of valuables
The Security Officer, Admitting clerk and appropriate party will proceed to PBX office to obtain Safe key and to continue to Safe location
The Security Officer will verify the receipt with log entry and remove property envelope from the safe

39. Procedure for Release of Valuables
The Security Officer will open the envelope and verify the contents with the Patient’s Funds and Valuables Record and have the witnessing party sign the property log
The Security Officer will sign the log and replace it in the safe and lock it with the Admitting Clerk verifying the locking of the safe
The Security Officer, the Admitting clerk and appropriate department staff will proceed first to PBX office and return safe key with the Admitting clerk signing the log for return
The Security Officer and appropriate department staff will proceed to the designated area to return the valuables to the patient and obtain all required signatures for release and the original form for release of valuables from the Financial Counselors

40. Procedure for Release of Valuables
In the event of any discrepancies such as missing money, jewelry, etc, the Security Officer shall immediately advise the Director of Public Safety and Risk Management/Patient Relations
The Main safe will be maintained in a locked key box in PBX (BHS safe key will be maintained in a locked key box in BHS Nurse’s station). The key shall be signed for each time it is taken from the key box and returned.
When a patient is transfered within the facility, the discharging department will follow the process for release of valuables and accepting department will follow the process for securing of valuables.

41. Partial Release of Valuables During Patient Stay
Procedure to release SOME contents of valuables envelop while retaining other items OR to add to the valuables already received.
Follow the steps from procedures for release of valuables.
Obtain verifying signature from the patient that all items are correct in the envelope. The original copy of the Valuables Release Form to the Cashier's Office
Release to the patient the items requested and/or receive any additional items to be secured for safekeeping
Itemize all items not released and any added items on a new valuables envelop
Proceed with the deposit of new envelop

42. Partial Release of Valuables During Patient Stay
Document any discrepancies
Itemize any property envelopes remaining in the safe after patient discharge or expiration and release them to Risk Management/Patient Relation for disposition
All releases shall be signed out in the property log by Security Officer and Risk Management/Patient Relations representative accepting the property

43. If in doubt or have questions regarding release of patient valuables, contact your house supervisor for assistance

44. Thank You