Nurse considers guidance in 2.68 of Code

The nurse considers guidance as set out in 2.68 of the Code including the
potential for the patient to leave before the arrival of the doctor and the
possible consequences, including harm that might occur to that person or
others if the patient is allowed to leave.

What should the nurse do before using this power?

The Code states that before using the holding power the nurse should
a) The likely arrival time of the doctor as against the likely intention
of the patient to leave. Most patients who express a wish to leave
hospital can be persuaded to wait until a doctor arrives, to discuss
the matter further. Where this is not possible the nurse must try to
predict the impact of any delay upon the patient; and

b) The consequences of a patient leaving hospital immediately
including the harm that might occur to the patient or others taking
into account:

  • What the patient says he will do and his known history;
  • The likelihood of the patient committing suicide;
  • The patient's current behaviour and in particular any changes
    from usual behaviour;
  • The likelihood of the patient behaving in a violent manner;
  • The availability of appropriate accommodation and support in the
  • Any recently received messages from relatives or friends;
  • Any recent disturbance on the ward (which may or may not have
    involved the patient);
  • Any relevant involvement of other patients
  • Any relevant information from other members of the multidisciplinary

Can the nurse be directed to use this holding power?

No. The code states that the decision to exercise the holding power is at
the personal discretion of the nurse who cannot be instructed to exercise
this power by anyone else. Code 2.68