Medico-legal and ethical aspects in the management of wandering patients following brain injury: questionnaire survey.
BACKGROUND
Different methods are often used to deter head injury patients, who have a tendency to wander, from leaving the rehabilitation wards. The extent to which these patients could be restrained is controversial. Despite the fact that the majority of these patients lack mental capacity, Mental Health Act sections are rarely invoked. Under common law, informal patients should have the right to refuse treatment and to leave the hospital whenever they like.


OBJECTIVE
To examine the current practice in the management of wandering patients following brain injury in rehabilitation units in the UK and to formulate practical guidelines based on this common practice.


METHODS
A postal survey in the form of a structured questionnaire was sent to 58 consultants in Rehabilitation Medicine and Neuropsychologists based at different neurological rehabilitation units in the UK.


RESULTS
A total of 30 clinicians (52%) completed the questionnaire. One-to-one supervision was the method most commonly used to manage wandering patients (83%) followed by implementation of a structured daily routine (73%) and the use of different medications (70%). Only 17% would lock the door without giving the patient lock combination/key and another 17% would physically restrain the patient without invoking mental health act (MHA) section; 60% would consider MHA section with great variability in the mental health team response time and the place where patient is managed once under MHA section.


CONCLUSIONS
The questionnaire showed great variations in the methods and the medico-legal framework used in the management of wandering patients. There was, however, a tendency to avoid physical restraint which may reflect the recognition of the unlawfulness of detaining informal patients.
Gaber
Tarek A-Z K
TA
Leigh Infirmary, Greater Manchester, UK.
D001930:Brain Injuries / Q000534:rehabilitation*; D006801:Humans; D017410:Practice Guidelines as Topic; D011595:Psychomotor Agitation / Q000534:rehabilitation*; D012149:Restraint, Physical / Q000941:ethics / Q000331:legislation & jurisprudence / Q000379:methods; D017751:Safety Management / Q000941:ethics / Q000331:legislation & jurisprudence; D011795:Surveys and Questionnaires; D006113:United Kingdom; D016138:Walking