LEAVE OF ABSENCE - PATIENT (Day/Overnight Pass)

POLICY STATEMENTS
A patient may be granted a temporary leave of absence (day or over-night pass) as part of a planned
therapeutic program on a prescriber's written order. A leave is not to exceed 72 hours.
An “Authorization for Patient's Leave of Absence for Therapeutic Purposes” form must be completed and
signed by the parent/guardian and nurse prior to patient leaving.
An alternate caregiver may be granted permission by the parent/guardian to escort patient on a leave of
absence (pass).
All inpatient children at BCCH/SHHC who may require transportation for an outing, will have a transportation
plan developed and reviewed by the family/legal guardian and the Interprofessional Team prior to first
transport, to ensure and enable safe transportation of the child.
Team members will function as per defined Family & Interprofessional Team Roles & Responsibilities.
The provision of safety equipment for transportation is the responsibility of the family/legal guardian with
consultation from the Inteprofessional Team.
Staff will ensure family/guardian/alternate are aware of Best Practice Guidelines from the BCAA Traffic Safety
Foundation for the use of child car seats and use of seat belts when transporting their child on outings. (BCAA
Traffic Safety Foundation – Child Car Seats at http://www.bcaaroadsafety.com/child-passenger-safety/).
PROCEDURE Rationale
1. CHECK chart for prescriber’s order.
2. DETERMINE if family will be transporting child in Ensures utilization of appropriate car seat, seat belts or
vehicle and COMPLETE the Transportation Plan other transportation aides.
prior to first outing and REVIEW plan with family
prior to each outing. REFER to BCAA Traffic Safety
Foundation – “The four stages for your child’s
protection” for additional information related to use
of child car seats for children up to their 9th
birthday and under 145 cm (4’9”) and seatbelts for
children over 9 years of age. REVIEW Wheelchair
Transportation “Safety Tips” if child to be
transported via wheelchair.
3. NOTIFY pharmacy at least 24 hours prior to To allow pharmacy adequate time for processing
scheduled outing if possible if any medications will request.
be required. Refer to Dispensing Medication to
Medication schedules should continue while patients
Patients granted Temporary Absence from Hospital
are on outings.
policy for more information.
4. REVIEW child's care plan with Ensures care provider is prepared to care for child’s
parent/guardian/alternate caregiver prior to outing, medical needs as required.
including emergency response (e.g. seizure safety,
G-tube safety, administration of medications,
central line emergency care, etc).
5. OBTAIN supplies and equipment as necessary, Ensures appropriate supplies and equipment are
such as: available to provide care, emergency support and
a. Child’s regularly scheduled medications, monitoring during outings.
feeds, etc.
b. Child specific emergency medications and
protocols (e.g. Seizure medications, EPI-
pen).
c. Emergency equipment (e.g. Tracheotomy
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 LEAVE OF ABSENCE - PATIENT (Day/Overnight Pass)

supplies, suction, AED, oxygen – if oxygen

dependent)
d. Appropriate sized airway/one-way valve/
emergency fanny pack
e. Mobility aides
f. Transportation aides (e.g. car seat)
6. INSTRUCT family that if immediate medical Ensure appropriate level of emergency support is
assistance is required during outing, they should: obtained.
a. Initiate emergency treatment as appropriate
b. Call 911 if emergency assistance required
7. ENSURE "Authorization for Patient's Leave of Shifts responsibility for care to parent/guardian during
Absence for Therapeutic Purposes" form is outing.
completed and signed by the parent/guardian.
8. CONFIRM that caregiver escorting patient (if not Ensures that alternate caregiver is authorized to escort
parent/guardian) has been appointed as an patient on outings.
alternate caregiver by parent/guardian on
authorization form.
9. GIVE instructions for medication, diet, activity Ensures continuity of care during outing.
required when patient is on leave to
parent/guardian/alternate caregiver and document
on authorization form.
DOCUMENTATION
DOCUMENT on “Authorization for Patient’s Leave of Absence for Therapeutic Purposes” Form and other
appropriate records (e.g. MAR, Nurses Notes):
o Date and time of departure and return
o Name and contact information of person accompanying patient
o Outing location/destination
o Medications taken while on outing
o Patient's physical and/or mental status at departure and upon return
o How patient tolerated outing
o any other pertinent actions or observations

REFERENCES
British Columbia Automobile Association. Traffic Safety Foundation Best Practice Guidelines: Child Car Seats.
Retrieved April 21, 2010 from http://www.tsfbcaa.com/11.aspx.
British Columbia Children's Hospital. (2009). Pediatric Transport Guidelines. Vancouver, Author.
British Columbia Children's Hospital. (August 2006). The Halo Thoracic Brace Patient/Family Resource
Pamphlet. Vancouver, author.
Rehabilitation Engineering Research Center (RERC) on Wheelchair Transportation Safety. Guidelines for Use
of Secondary Postural Support Devices by Wheelchair Users During Travel in Motor Vehicles.
Pittsburgh, PA: Rehabilitation Engineering Research Center on Wheelchair Transportation Safety;
2006. Retrieved April 21, 2010 from
http://www.rercwts.org/RERC_WTS2_KT/RERC_WTS2_KT_Pub/RERC_WTS_Pub_Doc/RERC_WTS_
032_06.pdf
Sunnyhill Health Centre for Children. (2007). Vehicle Transportation Of Children Who Use Wheelchairs Or
Special Needs Strollers. Vancouver, author.
Sunnyhill Health Centre for Children. (2007). Transporting Infants and Children with Special Needs: For
Professionals. Vancouver, author.
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Transporting Infants and Children with Special Needs in Personal Vehicles: A Best Practices Guide for
Healthcare Practitioners, 2008, Road Safety Transport Canada. Retrieved April 21, 2010 from
http://www.tc.gc.ca/eng/roadsafety/tp-tp14772-menu-155.htm.

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