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Solving the patient protection problem.

FEDERAL "NO RESTRAINTS" LEGISlation, liability issues, and safety concerns have forced many nursing homes and hospitals to reevaluate their methods for managing patients who wander. These patients are at risk because they are prone to wander not only inside a premises but also beyond its boundaries.

This challenge has given rise to a number of sophisticated wanderer control systems. Comparing each systems' strengths and weaknesses can make the choice confusing and difficult. When deciding which system to recommend, the health care security manager must balance each element against the needs of the nursing home staff and its patients.

Generally, wanderer control systems consist of a tag worn by the patient that activates an exit alarm. Both active and passive systems are available. Passive tags react to a generic signal from the hardware at the exit. Active tags are transponders that send back an intelligent signal to a radio frequency emitted at the exit.

Passive tags are usually larger than active ones and can require bulky hardware at the exit. Active systems often resemble a wristwatch in size, shape, and weight and can operate with hidden antennae that cover the entire exit periphery.

Because they react passively to the hardware, passive tags often come with lifetime warranties. Active tags can be guaranteed for malfunction and battery failure for as long as 10 years. Active tags can also be coded individually to track a patient's wandering pattern, which can help staff members know when and where a specific wanderer is likely to exit. This feature can save time when an emergency arises.

The type of tags used for wandering patients should place minimal demands on staff. Long-lasting tags do not require nurses to check and replace batteries. If a battery is used, the tags should have low-battery flags. A system that requires little staff training and maintenance will be used more often.

The proper system can add safety and dignity to the life of the wandering patient. But if the patient won't wear the tag, even the most sophisticated system is useless. Hidden antennae in doorways and discreet wrist tags give a different impression than systems that make a patient appear handcuffed. When deciding on a facility for a wandering patient, family and friends may be swayed by whether the tagging system is obtrusive or discreet.

THE TAGGING SYSTEM'S ALARM SHOULD cover the entire exit. Mat systems, in which the alarm hardware is located in a mat at the doorway, can present critical detection problems if, for example, the wandering patient is leaving by wheelchair.

A number of systems offer magnetic door restraints that are activated by the wanderer tag worn by an approaching patient. These locks, when tied into a fire alarm system, have been approved by fire marshalls and inspectors. Magnetic locks that release when a fire alarm sounds have been approved by the National Fire Prevention Association.

Keypad locks can be installed that allow staff to exit in an emergency by using a bypass code. However, patients and visitors who do not know the bypass code must also be able to leave the area. A solution is to separate patient and employee needs.

For example, a system can be set up so that when a patient approaches the exit, magnetic restraints lock the door. But if someone pushes the door for two seconds, an irreversible timer is activated that opens the door in 15 seconds, allowing exit in an emergency. With this configuration, ample warning is given so staff can react if a wandering patient attempts to leave.

A similar procedure should be installed at the elevators. If a wandering patient approaches the elevator, the wrist tag should disable the elevator and alert nurses to the patient's location. If the amount of elevator traffic makes such an approach impractical, the tagging system should set off an alarm when the elevator button is pushed.

Whether securing an exit or an elevator, the keypad is an integral part of the hardware. In addition to enabling staff to reset the system after an alarm, the keypad should contain a number of codes that staff can use to bypass the alarm.

To prevent wasting time trying to locate the exit a wandering patient is using, the system should identify exactly which exit has been opened. The wanderer can gain precious time if staff must search the premises to find him or her, particularly if the facility has many exits.

Effective individual patient coding and exit identification depends on a control system that alerts staff at a nursing station. However, a system that allows staff to turn off the alarm at the nursing station is not recommended. Disregarding an alarm should be impossible because a person must reset the alarm at the door.

The reasons for installing a wanderer control system are growing. Critical safety and liability issues make this an important decision. Demand has created wanderer control systems that meet virtually every need. But the range of offerings makes review and comparison an essential part of an intelligent, cost-effective decision.

Edward T. Dean, CPP, is vice president of technical services at D/A Technology in Needham, MA. He is a member of ASIS.
COPYRIGHT 1992 American Society for Industrial Security
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1992 Gale, Cengage Learning. All rights reserved.

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Author:Dean, Edward T.
Publication:Security Management
Date:Sep 1, 1992
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