Patient's leave from Bradgate Unit, at Glenfield Hospital not logged, Leicester inquest told
A patient with a history of suicide attempts was allowed out of a locked ward by a health care support worker who did not tell senior staff or log the incident.
The second day of an inquest was told yesterday that Sally Ann Vye was allowed out of the Bradgate Unit, at Glenfield Hospital, as the assistant went off duty.
In the early hours of the following morning Miss Vye's body was found at the foot of Beachy Head, a notorious location for suicides on the Sussex coast.
Miss Vye, 39, from Tennyson Way, Melton, had been admitted to the unit's Beaumont Ward on June 9 last year, under section two of the Mental Health Act, after already being found on the cliff edge.
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The Leicester Town Hall hearing was told being allowed out by a care support worker was one of a number of breaches of policy and procedure surrounding Miss Vye's disappearance.
Health care support worker Matthew Coring said he had looked at a ward document which said Miss Vye had been given the freedom to leave the Beaumont Ward unsupervised for a maximum of 30 minutes.
As he was leaving work at 2.25pm on June 19 he allowed her out of the ward. However, despite hourly ward head counts, Miss Vye's disappearance was only discovered when her parents rang to check on her nearly eight hours later. According to hospital policy, such leave should only have been granted by a registered nurse who would have signed a timed document.
Mr Coring, however, said: "It was common practice for us to sign patients out and record it on the in and out board."
But he admitted he had not recorded her departure or told the nurse in charge.
The inquest heard that the in and out board, also known as the "on and off" sheet, was supposed to record the whereabouts of patients in the 22-bed ward. But it had been badly filled in by staff.
Coroner Catherine Mason told the hearing: "Not one of the entries for five days covered on the sheet have been filled out correctly. And on June 19 there are no entries."
Carol Scarborough, who was matron of Beaumont Ward at the time, agreed the sheet, if filled out properly, was a crucial tool for patient safety.
She also agreed her ward only did head count checks once an hour, contrary to hospital policy for 30 minute checks.
She also assumed the policy of senior staff issuing a Section 17 leave pass to sectioned patients was being followed.
She said she assumed other policies were being carried out when, in fact, they were not.
Deputy ward matron Lisa Lloyd, who was in charge of the ward when Miss Vye went missing, said she was never told of her disappearance.
She did not receive a handover document from the previous shift which would have detailed patients on the ward.
The hearing continues.