Safety & Security: Patient Care Environment

The facility should help the patient get settled in their new environment. Along with general instructions on how to use facility/room amenities, instruction should also be given on how best to keep track of their belongings.

It is suggested that an awareness system be implemented for belongings commonly retained in the patient’s possession (e.g., dentures, hearing aids, and glasses). Tent cards or magnet boards can display symbols for any of these belongings being used by the patient, which should provide an instant reminder for staff entering the room that these items are in use.  If the staff member does not observe the item identified on the display, they should be instructed to inquire as to its location. This will help to insure that housekeeping staff do not remove waste material before they know all belongings are still in the room, and/or dietary staff don’t remove trays until belongings are accounted for. 

Symbols and explanation for specific items are listed below:

Dentures – A clear, see-through dentures cup should be issued to the patient.  The patient should be instructed on the cup’s use and made aware that dentures are not to be placed on any food trays or next to any waste receptacle.  A patient identification label should be placed on the cup.

Hearing Aids – A clear, see-through hearing aid container should be provided to the patient.  Again, a patient identification label should be placed on the container.  Consideration should be given to issuing the patient a hearing aid retainer, which helps to insure the hearing aid is attached to clothing in the event it becomes dislodged. (Note: New technology has significantly decreased the size of hearing aids where they may not be readily detectable through casual observation and attaching a hearing aid retainer may not be possible.) Patients should be instructed to place their hearing aid in the container when not in use and to keep this container off of food trays and away from waste containers.

Glasses – A clear, see-through glass case should be issued to patients. A patient identification label should be placed on this container.  Patients should be instructed to place their glasses in this case when not in use and to keep this container off of food trays and away from waste containers.

Consumer Purchases

The ability for a patient to make minor purchases certainly raises issues for securing cash.  Consideration should be given to implementing a moneyless system (e.g., debit card) which eliminates the need for cash used for daily purchases (e.g., newspapers, gift shop items, etc.). The system can be set up similar to a pre-paid debit card, where an amount of cash is provided up-front and then the account is only replenished upon depletion. 

Transport

Another time when there is a high risk of belongings being misplaced is when a patient is transported to and from rooms/departments. Often times the simple stress of a test or procedure is enough to draw the patient’s attention away from tracking their personal possessions. In many instances, medication and/or anesthesia can also contribute to the distraction.

Before departing from the starting point, the staff member should question the patient about his/her belongings, making note of the postings for life-essential items. The patient should be advised to only take those necessary items with them, and all other belongings should be properly secured before leaving the room. In lieu of securing items in the main facility safe, facilities should consider installing small in-room safes for securing day-to-day items needed by the patient. If an in-room safe is not available, then the belongings need to be placed in the facility safe (see inventory protocols) or provided to a designated family member (documentation of the transfer must be recorded). 

For those items going with the patient, a transport tracking log should be completed. The transporting person and patient should review and initial the form. A copy should be placed with the medical record and a copy retained by the transporter. At each transport point, the form should be checked and those items taken with the patient identified as to whether they are still in the patient’s possession, with the transport person and patient initialing confirmation. Any discrepancies must be reported immediately to security.

The procedure for department transfer should be identical to the transport requirements.

Discharge

When staff is made aware of the patient’s discharge time, they should ascertain whether the patient placed any belongings in lockup. If they did, then arrangements need to be made to bring those items to the patient’s room immediately prior to discharge.  The contents of the belongings storage envelope should be inventoried and witnessed by the patient, verifying the form contained in the envelope is correct.

Before the patient leaves, a final check should be made of the room, all belongings accounted for, and the final inventory form signed by all witnesses. A copy of this form should be kept in the patient record, and a copy provided to the patient being discharged. If items are unaccounted for, then security needs to be contacted and an investigation initiated.

Patient Expiration

In the event a patient should expire before discharge, all patient belongings, to include those items worn by the patient, should be collected, inventoried, and placed in a belongings envelope by a minimum of two (2) hospital staff. Once the inventory is complete, two (2) staff members should sign the inventory form, place it in the belongings envelope, and the envelope sealed.  If a designated person is not available to pick up the belongings, then security should be contacted and the belongings placed in lockup following protocols. If a designated person is available to pick up the belongings (confirmed by proper identification and photocopy of same), then the belongings can be released provided they sign an inventory receipt.

If an item cannot be removed from the patient, then security should be summoned. Those items should be inventoried and then secured on the patient (e.g., taped in place). An inventory of the belongings left on the deceased should then be drafted, signed by the person performing the inventory along with another staff employee witnessing the inventory, and maintained with information to go with the body.  When the body is released to the funeral director, the contents of the belongings envelope and the items remaining on the deceased should be visually verified. Upon verification, the form should be signed by the person picking up the body and by the facility representative. One copy of the form should be kept at the facility with the patient’s medical record, and one copy should be provided to the person picking up the body.

If there is a discrepancy in the deceased’s belongings inventory and verification cannot be made during the release of the body, then security must be notified immediately, the discrepancy documented, and an investigation launched immediately. 

Adding/Removing Belongings from Lockup

The following practices should be taken into consideration whenever patient belongings are either placed into or removed from the belongings lockup.

• Two (2) staff members should always be present to witness what is being done.
• A log book should be kept and each witness should sign upon opening the safe.
• The safe doors should have an alarm that reports to a main monitoring location (e.g., hospital operators) whenever they are opened.  Security should be present at each opening, and should report a safe opening to the central monitoring location (if applicable), where a log is maintained to properly document pertinent information (e.g., date, time, individuals present when the safe was opened, for what purpose, the belongings envelope number or identifier, time secured, etc.).
• The safe locking mechanism or area access should provide an identification tracking system, which provides a history of who is opening the safe (e.g., card reader.).
• The area should be monitored by a camera and recorded.