When a patient goes absent without leave (AWOL) procedure

1 Aim

The aim of this document is to provide service specific guidance for colleagues  who work in the forensic service when dealing with an absent without leave (AWOL) situation to ensure effective management and reporting of the incident, meeting the requirements of the Care Quality Commission (CQC).

2 Scope

This document applies specifically to the forensic service and provides procedural guidance for use of colleagues working in this service including bank and students.

3 Link to overarching policy

This procedure will run in conjunction with the trust policy for patients missing or absent without leave (AWOL) policy.

4 Procedure

4.1 Definition

The term absent without leave (AWOL) in the forensic service is defined by the NHS secure commissioners as “any situation where patients are absent without agreement or planned leave or have not returned from leave”.

4.2 Action to be taken if a patient goes absent without leave whilst an inpatient in the forensic service

• Colleagues must immediately notify the nurse in charge.
• Organise an immediate search of the surrounding area.
• Notify switchboard of the absent without leave (AWOL).
• If the search is unsuccessful, notify the police immediately and complete a missing person (police form), making clear the patient’s legal status, multi-agency public protection (MAPPA) status and identifying all risks and management plans.
• Notify the responsible clinician and management team during working hours.
• Notify the Mental Health Act (MHA) office and if applicable the Ministry of Justice (MoJ) of the absent without leave.
• Instruct the provider collaborative: scn-tr.qualityandperformance.sybpc@nhs.net regarding the absent without leave including the case manager if known for the individual patient.
• Out of hours, contact the on-call consultant and the bronze level manager who can escalate the situation appropriately within the on-call structure within the trust.
• Notify switchboard as they may receive calls with regard to the missing person.
• Notify the patient’s next of kin if appropriate as the patient may make contact with them.
• Comprehensively record all action taken into the patient’s electronic clinical record, SystmOne.
• Register the patient as absent without leave on SystmOne.
• Complete an electronic incident report form within the RADAR platform.
• In the event that the patient does not return to the ward by midnight on the first day of absence complete and email the Care Quality Commission absent without leave notification form to the Care Quality Commission. Then send the original to the service manager or matron or Mental Health Act office.

4.3 Action to be taken if there is an identified risk to person or persons in the event of a patient going absent without leave

• Colleagues must refer to the patient profile sheet which will detail identified risks. This is found in the front of the patient file, as per business continuity planning requirements.
• Colleagues will need to use the above information to inform anyone identified in the patient’s risk assessment and risk management plan of the fact the patient has left the unit unsupervised.
• Identify any victim issues that need to be taken into account and liaise with police as appropriate.
• Determine if the patient is subject to multi-agency public protection arrangements (MAPPA) and if so notify them.
• Any child or adult safeguarding issues notify the appropriate social service or duty social worker outside of normal working hours.
• Notify switchboard who may receive any calls about the missing person.

4.4 Action to take if the patient has not returned to the unit by midnight on the first day of absence

• Complete part 1 of the Care Quality Commission absent without leave notification form and send immediately to the head of service and modern matron ensuring a copy is also sent to the Mental Health Act office for submission to the Care Quality Commission.
• Notify NHS England of the incident.

4.5 Action to be taken when the patient returns

• Complete a full search upon return to the unit
• Complete alcohol and drug testing if clinically indicated.
• It is the responsibility of the nurse or clinician in charge to inform everybody previously notified of the patient’s absence of their return. This includes out of hours the bronze command on call manager.
• Nurse in charge should only contact the on-call doctor outside of normal working hours about the return of an absent patient if there are concerns about the patients’ mental state or physical presentation and the medical attendance is needed.
• Suspend any further planned section 17 leave until a review can be undertaken by the responsible clinician and multi disciplinary team.
• Modern matron to instigate after action review and share any learning in the directorate and the wider trust is required.
• When a patient who absconds has been reported to the Care Quality Commission and returns, part two of the Care Quality Commission absent without leave notification form is to be completed and emailed to the Care Quality Commission and a copy to Mental Health Act Office to them (see appendix A).

5 Appendices

Please see forensic services manual webpage for appendices attached to this procedure.

• Appendix A admission to inpatient learning disability forensic services procedure

Document control

• Version: 3.
• Unique reference number: 530.
• Approved by: Clinical effectiveness group.
• Date approved: 13 May 2025.
• Name of originator or author: Interim service manager forensic and learning disability directorate.
• Name of responsible individual: Chief nursing officer
• Date issued: 25 June 2025.
• Review date: 30 June 2028.
• Target audience: For all colleagues working in the forensic service.
• Description of change: Minor amendments.

Page last reviewed: June 24, 2025
Next review due: June 24, 2026