Minimizing risk in the nursing home

Nursing Homes, Jan-Feb, 1992 by Leo G. Foxwell

In addition, the safety committee should regularly inspect the premises and promptly correct and sources of trouble. If an accident does occur, an efficient response system should be in place, including specific plans to make certain the accident does not recur.

Wandering and Elopement

A resident's initial week or two are the most critical for assessing this type of nursing home risk. Naturally, the resident is unfamiliar with the layout of the facility, all the new people and the new lifestyle. These sudden changes can easily cause disorientation, depression, withdrawal and restlessness, all of which contribute to increased wandering and attempts to elope or escape.

It is interesting to note that a significant number of falls also transpire during these first two weeks of a resident's stay in a nursing home.

One can usually identify those residents prone to wandering and elopement, and every effort should be made to do so upon admittance. Prime candidates for problems are residents who are mobile, residents with a history of wandering or attempted elopement, or residents who are either slow or resistant in adjusting to admission.

Having an alert staff to provide close supervision is one vital approach. But, since no one can be watched 24 hours a day, other lines of defense need to be set up.

Exist alarms are one of these defenses. Having alarms on all exit doors is an important safety precaution for several reasons. First, they they provide a level of security against intruders and, second, they can alert the staff to people leaving a floor or the preimses, as in the case of a wanderer or an eloper.

However, exit alarms are only a source of security when they are properly used. They have to be activated. Unfortunately, it is not uncommon for some of them to be deactivated during the day with the staff going between floors and not wanting to bother about the alarm. This may explain why at least one-third of elopements take place during the day.

Also, staff reaction to the alarm is an important factor. Staff often go about their business when an alarm sounds, figuring that it is an authorized use of the exit, and then often simply reset the control panel. Some alarms even stop ringing once the door is closed. This lack of response to the danger signal can result in tragic occurrences. A disoriented resident, even in a wheelchair, could push open the door and pitch down the stairs or be out in the street in a matter of seconds.

To minimize such happenings, nursing homes must have a firm and written policy regarding exit alarms. When a staff member hears an alarm, they must investigate immediately.

The most positive approach is to use an individual resident electronic elopement control device for all potential wanderers. These devices will allow visitors and others to exit through regular doors without an alarm, but the patient "eloper" when wearing the electronic device will trigger the exit alarm. All newly admitted residents should wear such a device until their potential for wandering can be established. The individual elopement device is the most practical alarm.