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 hospital or clinical area 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.

[sixes]

Where I work we have a secured unit. The doors all have codes

The door leading to outside goes to a secured area.

We seldom use restraints as we find this just makes the resident more resistive to care or more aggressive.

I have been there for one year and have only use a chemical restraint once and that was for the safety of staff and the resident herself

We believe in gentle care and we try very hard to follow the residents routine and not ours.

I hope this helps you alittle

[AlixCoastRN]

We have a 'secure' unit with keypads on the doors for entry and exit. We have one restraint - a lap buddy on a lady who actually has more of a secure feeling with it on. We also have the lock/keypad system on all the doors going outside thruout the building. We have 'wandering' residents in the general population. As far as falls, most are due to fatique, low blood sugar, and the like. If we have a resident who is more at risk for injury due to poor safety awareness, insomnia, agitation we usually will ask a family member to stay with them. We do a falls risk assessment on admit, and have a questionaire for people to complete if a resident is coming to the community. Our admissions are based on if we are able to meet their needs and if we have an appropriate bed.