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Providing unrestrained care.

AS GERIATRIC CARE BECOMES A growing concern to Americans, technology that enhances the quality of life is becoming as important as technology that prolongs it. A new federal regulation strictly limits the use of patient restraints in hospitals and nursing homes. While this regulation improves the quality of life for patients in such institutions, it poses unique security problems for the facilities. Fortunately, electronic solutions are available.

In the past, chemical and physical restraints (straps that bind a patient to a bed or chair) have been used to protect patients from falls and from wandering off. Falling and wandering are a danger for patients and a liability concern for health care facilities.

Although these restraints have been effective, they are also controversial. In 1987, Congress passed the Omnibus Reconciliation Act, which strictly limits the use of chemical and physical restraints in health care facilities. In October 1990 that regulation went into effect. Today, protecting patients who wander must be accomplished through alternative means.

The law states that patients cannot be restricted for disciplinary reasons or for the convenience of the staff but only for a specific and valid medical reason. The staff must prove it has had no success in controlling the patients through any other means. When a physical restraint is used, it must be checked every half hour and released every two hours, and the checking and releasing must be well documented.

Electronic patient-wandering systems can solve the restraint problem. Such systems provide a safe, nonintrusive means of monitoring the location of patients in hospitals and nursing homes.

Wrist or ankle bands worn by the patients trigger an alarm as patients pass through sensors placed at the doors. The bands, or coded tags, eliminate false alarms because they work on a frequency not used by other equipment in the building. When a tag comes within range of a sensor, a microprocessor checks the code before it sounds an alarm. As the alarm sounds, the wandering patient's identity and location are revealed on the staff's control panel.

Until recently, wandering patients were a problem at Blueberry Hill Healthcare Center in Beverly, MA. The hospital had placed alarms on the emergency exit doors to alert the staff if the doors were opened. However, the hospital could not alarm the main entrance because of the heavy volume of people coming and going. A few patients repeatedly walked out the main entrance and down the driveway. The nurses were spending too much of their time tracking down patients, usually the same ones.

Philip Sher, administrator of Blueberry Hill, contacted D/A Technology, which installed an electronic patient-wandering system to cover the main entrance. The system incorporates electromagnetic door restraints but eliminates the noisy alarms.

The way the system works is that a transmittal device emits a continuous signal around each door. When a patient wearing a bracelet comes in contact with the signal, electromagnetic restraints are activated, placing pressure against the door and holding it closed. The door restraint releases when the person leaves the door area. Whenever door restraints are used, the fire marshal must inspect the system to ensure that it complies with all local fire codes.

Blueberry Hill currently has four patients monitored by the system. Sher explains, "We felt this system offered the most advanced and comprehensive protection for our wandering patients. We would have installed the system even if only one patient needed it."

Bob Hawthorne, administrator at the Friends Home of Woodstown in Woodstown, NJ, faced similar problems, only his problems were aggravated by the facility's close proximity to a busy street. When patients made it out the main door and down the driveway, they were in danger of being hit by a car.

Hawthorne contracted with D/A Technology to install a system to cover two doors, the ambulance entrance and the main door. All the other exits are protected by alarms that sound every time the door opens.

Hawthorne chose not to have electromagnetic door restraints installed. Instead, the system at the Friends Home sounds an alarm when a patient wearing a bracelet goes near the main door or ambulance entrance and that door is open. Eight of the 60 patients there wear access control bracelets.

"This is a reliable and cost-effective way for us to keep track of the patients," Hawthorne says. "It has worked for us, and our staff is able to monitor the patients closely without taking attention away from their care."

About the Author . . . Phil Anderson is vice president of sales for D/A Technology Inc. in Needham, MA. The company manufacturers, designs, and services surveillance systems. Anderson is a member of ASIS.
COPYRIGHT 1991 American Society for Industrial Security
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1991 Gale, Cengage Learning. All rights reserved.

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Title Annotation:Health Care Security; geriatric care
Author:Anderson, Phil
Publication:Security Management
Date:May 1, 1991
Words:773
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