Wandering and elopement technologies: a guide - health care risk management - includes related article on action recommendations

Nursing Homes, Oct, 1996

Editor's Note: Two years ago, ECRI, a nonprofit agency that has been involved in health care risk management for some 30 years, turned its focus on safety in long-term care. It assembled a Continuing Care Risk Management System, consisting of risk analysis articles, questionnaires, forms, checklists, on-line services, telephone consultations and a newsletter, all addressing safety concerns specific to nursing homes, subacute and rehabilitation units and assisted living facilities. ECRI gave Nursing Homes permission to reproduce an excerpt from a risk analysis article on commonly used technologies to control resident wandering and elopement. The excerpt follows:

Electronic Technologies

When used correctly, electronic devices (e.g., door alarms, video cameras, patient tracking devices) can greatly reduce the incidence and severity of potentially dangerous elopements. Beyond simple exit alarms that are activated when anyone passes through, many facilities now use elopement protection devices that are triggered only when certain individuals attempt to exit. These devices have battery-powered identification bands, anklets, or other "triggers" with built-in transmitters that cause an alarm to sound only when an individual wearing the trigger attempts to leave a secured area, thereby not restricting the free movement of other residents. Although most commonly used in nursing facilities, they are becoming more common in the rehabilitation field.[1]

The greatest drawback to any alarm system's effectiveness is misuse (e.g., staff disengaging or ignoring alarms, patients removing triggering devices). Cost is often cited as a deterrent to purchasing electronic wandering and elopement control systems. Their cost, however, must be weighed against the repeated cost of searching for wanderers and the increased potential for serious losses. Wrist bands and other devices on clothing that trigger alarms to warn staff that a resident is leaving a room or facility do not, in and of themselves, restrict freedom of movement and are not considered restraints under Federal Medicare and Medicaid nursing home regulations.[2]

Experts recommend contacting other user facilities before purchasing any electronic wandering-control system. Suggested questions to ask include.[3]

* Does the system work in all weather conditions?

* Has it actually prevented or reduced patient wandering?

* Does it break down? How often?

* How are repairs accomplished? How are replacement parts obtained?

* How frequent is service required?

* If you have to do the installation yourself, is it as easy as the manufacturer says?

* If the manufacturer does the installation, is it satisfactory?

* What complaints have you made to the company? How did it respond?

* How reliable are the manufacturer's sales or service people?

* What is the cost of maintaining the system? What do the triggers cost, and how often do they need to be replaced? What is the cost of batteries or electricity?

* What are the nursing staff attitudes toward the system?

* How do nurses respond when an alarm sounds?

* Has staff frustration ever led to the system being shut off? How often?

* What staff training will be needed?

* How many false alarms are there? For example, does electrical interference complicate the system?

In getting names of previous customers from the manufacturer, try to match them with your own facility (e.g., similar size, number of floors, number of exits, location of residents).

Door Alarms

Door alarms have a twofold purpose -- to create a deterrent for the eloper and to notify staff. Alarms must be reliable. If a system is set up to detect only the presence of certain residents, for example, make sure false alarms do not occur. Anytime an alarm sounds, it must be attended to. Even a few false alarms may result in less staff diligence. Staff sometimes fail to respond when an alarm sounds, assuming that it is an authorized use of the exit.

Obviously, an alarm system is useless if no one follows through and investigates. All facilities should have firm, written policies regarding exit alarms. When staff members hear an alarm, they must investigate immediately. Alarms should not be able to be reset from a remote location such as a nursing station; they should reset only at the door. Obviously, alarms must be loud enough for staff to hear. When designing a system, take into account that there might be no one at the nursing station when the alarm sounds (particularly at night).

Locking Systems

Local fire codes and the fire marshal should be consulted before a decision is made to lock any exit doors. Doors that lock when certain persons approach or require special procedures for opening (e.g., coded locks, magnetic locks, cardreading systems) can be fire hazards without appropriate release mechanisms built in and may not be permitted. In some buildings and in some jurisdictions, doorlocking systems can be wired so that door locks are automatically turned off when the fire alarm system is activated. Local licensing may be required.