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

Nursing Homes, Oct, 1996

In March 1994, the Health Care Financing Administration (HCFA) issued a Life Safety Code (LSC) interpretive update to the guidelines for LSC surveyors with respect to locked doors in long-term care facilities and psychiatric hospitals.[4]

The guidelines allow locked exit doors in psychiatric hospitals and intermediate care facilities for the mentally retarded (ICF/MR), provided that all locked exit doors are keyed to a master lock and ALL staff carry a key on their person at all times while on duty in the facility. If a surveyor finds that any staff member does not have a key on his or her person, then special locking arrangements may be required.

The guidelines further allow doors to wings in a health care facility to be locked to accommodate persons with special needs (e.g., persons with Alzheimer's disease) if the following caveats are observed: (1) The lock must release upon loss of power or activation of the building fire alarm. (2) Any required fire protection system (e.g., smoke detection system, sprinkler system) is tied into the fire alarm system. (3) There is an override system, such as a digital keypad, push-button release, or key locks, depending on the nature of the individuals served in the wing. If key locks are used, ALL staff must carry keys on their person at all times. (4) Locked doors must not be used to replace staff or in violation of resident rights provisions of the Federal regulations.

References

[1.] Electronic article surveillance systems in health care -- An update. Hosp Secur Saf Manage 1995 Jan; 11(9);5-10.

[2.] 42 CFR 483.13. Resident behavior and facility practices interpretive guidelines.

[3.] Supra note 32.

[4.] Health Care Financing Administration. Additional Guidance to Surveyors Life Safety Code. Memorandum. March 10, 1994.

Action Recommendations

* Establish protocols to identify potential wanderers upon admission to nursing, rehabilitation or other continuing care facilities.

* Continue wandering assessment into the first few days of the resident's stay -- remember that elopement attempts are most likely to occur in the first two to three days.

* Carefully document in the resident's chart all admission information received from the residents family or from other institutions, and the results of independent assessments or observations with respect to wandering, confusion or elopement attempts.

* Document notes on safety precautions taken at the time (e.g., additional supervision, room placement, electronic triggering devices, restraints).

* Make sure all caregivers are aware of an individual's propensity to wander. Ensure communication of wandering or elopement attempts from one nursing shift to the next.

* Implement the wandering prevention and management strategies appropriate for your facility.

* If electronic devices and alarms are used, ensure that staff are trained in their use, and investigate each time they are activated.

* Consult local fire safety regulations before installing any automatic locking device on exit or other doors.