risk management & wandering patients

[salisam]

I am preparing a dissertation for my post-registration BSc (Hons) Nursing Studies degree looking at risk management on an acute ward in those who exhibit wandering behaviour, for example, those with dementia or an acute confusional state/delirium.

I would be interested to hear about how your Trust, hospital or ward minimises risks to older patients who wander. Do you have guidelines relating to bedrail usage, restraint, and the management of acute confusional state/delirium and/or specific guidelines relating to the management of patients who wander? Does your hospital use security staff for patients identified as at risk of wandering off the ward; do you have additional nursing staff to watch/ 'special' the patient or a patient sitter scheme? Do you have open access to your ward or do you have any system of door locking or twin handle devices? Do you use any alarmed systems such as pressure mats to alert you when the patient has moved? Are these measures effective?

Thank you for your patience in reading this rather long message, I would be most grateful for any information you could share with me.

[trustmee]

I work on an organic admission ward and Wanderers are encouraged to wander within a safe environment under supervision. The level of observation for the person is increased if there are considered to be any additional risks that would result in harm to the person or others as a result of the wandering.

Our People are supplied with Hip protecting pants if they are assessed as unsteady on thier feet and at risk of falling and fracturing thier hips. In addition confusion locks are on some doors (exit doors in particular) as well as alarmed doors on some exit doors (although this is only switched on if there is a risk of a person overcoming a coded lock. The code for these doors are on a wall nearby each door as we have a locked door policy if the doors are 'locked'. This policy is in place so that people are not detained against thier will. To maintain a safe environment kitchens, bathrooms and store cupbords are kept locked and staff are on hand to observe patients (except when short staffed, then this procedure is not adhered to).

Use of restraint is unheard of and would be seen as cruelty. sometimes in exceptional circumstances protective head gear has been used when people have been repeatedly walking into walls, doors etc.. Close or special observation is best as the nursing staff can then develop better relationships with the client and it also give them a chance to try diversional therapies, laying tables, folding washing, anything physical but not too demanding mentally (or threatening). This also aids more accurate assessment of the persons mood, behaviour and needs.

When the restlessnes causes physical exhaustion to the person involved short term medication such as clonazepam has been prescribed, but the staff will need extra vigilance when observing as this can result in increased unsteadiness when walking.

I hope this is of some help to you

[Chaya, ASN, RN]

Our endangered pts. wear an ankle band that sounds an alarm if they open the door exiting the unit or are in front of the elevator when the doors open.