The Confused Patient Who Wants to Leave
A 79-year-old woman in a skilled nursing facility has mild dementia and a recent urinary tract infection. At 22:00 she is found in the hallway in her nightgown, trying to open the exit door, saying she needs to 'get home to feed the dog.' She is oriented to person only, does not know the date or facility, and becomes agitated when redirected. Her care plan includes fall precautions and a physician order for 'no restraints.' The facility has a locked unit policy but this resident is on an open unit. The night supervisor is off-site and reachable by phone.
1. What is the immediate priority and the appropriate interventions?
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Priority is safety: prevent elopement and falls without using restraints, which are prohibited by order and generally require specific justification. Interventions: stay with her, use calm redirection, guide her back to a safe area, offer a snack and toileting, and use a low bed/chair alarm if ordered. Notify the supervisor by phone and document the event. Do not physically block or restrain her beyond gentle guidance; do not leave her unsupervised at the door.
2. Does her statement 'I want to leave' constitute a lawful demand to exit?
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No. A resident with cognitive impairment who cannot understand the consequences is not making an informed refusal or demand. The facility has a duty to protect her from harm, and the no-restraint order plus fall precautions govern. The correct path is clinical redirection, notification, and care-plan review, not honoring an uninformed exit request.