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Wandering residents and elopement prevention

Betty Norman, BSN, MBA, CPHRM
Betty Norman, BSN, MBA, CPHRM

Adults with a history of Alzheimer's disease or dementia are at risk for wandering and elopement. Because this could result in an injury or fatality, consider evaluating existing organizational protocols and strategies to prevent elopement or wandering.

Identification and Assessment of Those at Risk

The first step is to identify residents who may be at risk to wander or elope. Elopement is defined by the National Institute for Elopement Prevention as “When a patient or resident who is cognitively, physically, mentally, emotionally and/or chemically impaired wanders away, walks away, runs away, escapes or otherwise leaves a caregiving facility or environment unsupervised, unnoticed and/or prior to their scheduled discharge.”

The assessment process, if done prior to admission to the facility, may help determine whether the organization is capable of properly and safely addressing the resident's care needs.

A reported history of wandering may indicate that an increased risk of elopement exists and that additional supervision and other precautions may be required. If there is a history of wandering, ask questions, such as:

  • When did the wandering behavior begin and how frequently does it occur?
  • Is it more frequent in daytime hours or at night?
  • Is the wandering associated with other factors, such as noise or discomfort/pain?
  • What type of travel pattern is exhibited (random, pacing, lapping)?
  • Does the wandering appear purposeful?

Once a resident has been identified as high risk to wander, share the information with all staff, not just nurses and other direct care providers. Add a “risk to wander” assessment to ongoing resident assessments.

Strategies for Prevention

According to the Alzheimer's Association, approximately half of all elopements occur within the first days of admission when residents are adapting to their new environment. It is therefore advisable to place new residents in rooms away from exits and closer to community areas, providing them with less opportunity to elope. If this is not possible, the staff must be vigilant in the initial days following admission, until they become familiar with the resident's behavior patterns and the resident becomes familiar with his or her new surroundings.

Many organizations use electronic equipment such as bed and door alarms, video cameras and resident tracking devices to help prevent wandering and elopement. These devices can potentially help reduce the incidence and severity of elopements. Give consideration to installing alarms on exit doors in resident care units or those that exit directly from resident rooms.

Missing Resident Protocols

It is important to have a missing resident protocol in place so that staff is aware of procedures to follow should such an event occur. Consider taking these steps:

  • Install an internal alert system to signal staff if a resident is missing and to implement response procedures. Assign staff to specific sections and use a checklist or shaded-in floor plan of searched areas to avoid duplication of efforts.
  • Initiate a systematic search of resident care units and other immediate areas: rooms, closets and stairwells, even those areas that are normally locked, along with the roof if there is roof access.
  • Make a thorough search of the grounds. Alert staff of potential hazards, such as parking areas, adjacent roadways or bodies of water, such as lakes or ponds.
  • Notify management, family members and physician(s).
  • Notify local police to request their assistance.
  • Document all actions taken either at the time of the incident or immediately after.
  • Form a plan of action for when the resident is located: Obtain a complete medical evaluation to identify potential injuries and provide necessary treatment. Also notify any previously contacted individuals (managers, family, etc.) of the resident's return.
  • Conduct an investigation to determine how the elopement occurred in order to correct any underlying contributing factors.

Being prepared to respond to a missing resident emergency is as important as preparing for other emergencies. Having protocols in place and providing adequate staff training are key to planning for this type of event. Periodic “missing resident” drills may prove very helpful. The main goal of managing wandering behavior is to protect the resident from serious injury or death. Focusing on assessing and identifying residents at risk and initiating strategies to prevent elopement can help your organization attain this goal.

Betty Norman, BSN, MBA, CPHRM, is Risk Control Director at Glatfelter Healthcare Practice, part of Glatfelter Program Managers, a strategic business unit dedicated to Glatfelter Insurance Group's program business.

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