dementia pt/wants out

[deetrain]

If a dementia pt attempts to escape through the exit doors...what should the CNA do?

[heron, ASN, RN]

Call for help and stay with the patient until the licensed nurse shows up. You can try to redirect or get between the pt and the door (but that might trigger an assault). I reinforce with my CNAs that they may NOT lay hands on or attempt to physically restrain the pt. This is one time when it's good to have a cell in your pocket!

[Double-Helix, BSN, RN]

Alert the nurse or other staff as soon as possible.

Attempt to get the resident's attention and divert him to another activity- snack, drink, phone call, etc.

Bring a wheelchair and try to get the resident to sit down.

Do not try to grab him or restrain him from going outside. The resident could get hurt, fall, or hurt you.

The biggest thing is you need to get some other staff to help.

[AgentBeast, MSN, RN]

Lay the wood to them.

Note I do NOT advise you do this. Not unless you want to go to prison. This is only a joke.

[heron, ASN, RN]

Alert the nurse or other staff as soon as possible.

Attempt to get the resident's attention and divert him to another activity- snack, drink, phone call, etc.

Bring a wheelchair and try to get the resident to sit down.

Do not try to grab him or restrain him from going outside. The resident could get hurt, fall, or hurt you.

The biggest thing is you need to get some other staff to help.

What she said, times two. What I've learned also is to control my own vibe. DON'T yell or get agitated yourself. Your job is to make sure pt is safe and that help is coming. If you're agitated, pt will be too and be that much more difficult to redirect.

Keep your voice low-pitched but a little bit loud - easier for pt to hear - but don't allow yourself to get shrill. And when help shows up, make sure only one person at a time is talking to the pt. Two or three people all telling the pt something different is too confusing for the pt and leads to no good.

ETA: I've also learned not to crowd the pt. I stay far enough away that the pt doesn't get upset but close enough to help if s/he needs it. I find that staying where the pt can see me helps keep them calm, too ... and helps them tolerate being physically touched. It's when we grab them from behind or without warning that they get scared. When that happens they either try to pull away (and fall) or hit back (hurting you and falling anyway).

VERY good question!

[Forever Sunshine, ASN, RN]

All our exit doors are alarmed. So the minute one of those doors opens all these bells and alarms go off. Even the deaf could hear it thats how loud they are lol. Definitely get help. Everyone usually comes running when they hear the alarm. Theres a little light at the nurses station that tells us what door was just opened.

I've caught a couple residents trying to get out the door a couple times. Don't get upset or frustrated because then they will get upset and frustrated. Ask them where they are going. Tell them they are staying the night here. Their family knows where they are and there is nothing to worry about.

[heron, ASN, RN]

I used to work in a state hospital built in the early 60's. No alarm system and no money for bed/chair alarms.

The head nurse got a couple of the heavy tin foil trays used by caterers and institutional kitchens. She poked a hole in the rim of each tray, tied them together to clatter when the door latch moved.

Not perfect and the sound didn't carry that well ... but cheap and way better than nothing!

[Sparrowhawk]

Let them out..it's their right.

No seriously, like everyone else said. But I will say I wouldn't be surprised in a few years that people will say this...it's already their right to fall etc...

[leslie :-D]

Ask them where they are going. Tell them they are staying the night here. Their family knows where they are and there is nothing to worry about.

i like this type of answer.

in other words, where is their mindset at?

usually, it is someone looking for something.

so you briefly but explain that 'someone' had called earlier, and told me/nurse to tell you/pt, that s/he had to do 'something'.

your goal is to keep them safe and pacify them.

leslie

[oramar]

The locked memory unit where my mom resides has very little problem with this sort of thing. The doors have locks on them that require a code punched in to open them. Most the persons on the unit have such advanced memory problems that they can't can carry out a task that complex. It is not a sure things but it makes it so much easier for the staff. Plus everyone wears a leg bands that set off an alarm if the person does get out. I think someone said that the person can be tracked by a signal the band gives off if all else fails. Now someone is going to tell a story about a patient that got past all the safe guards. Like I said it is not a perfect system but nicer than what I always had to deal with. We were always expected to intercept the patient at the door and turn them around. It was a really, really hazardous situation and would result in accidents and injuries for which the nurses were promptly blamed.

[Pepper The Cat, BSN, RN]

Try to divert them. Mention that its cold out - they need a jacket. Lets walk back to your room and get one then you can go out. Or ask them if they have their keys/wallet/purse - again lets go back and get them. Don't fight them, just re-direct them.

[vampiregirl, BSN, RN]

If all else fails and they do get out (and the weather isn't going to cause any immediate danger), someone should stay with them. Sometimes a quick (or slow) walk around outside and they can be easily redirected in another door.