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VHA National Center for Patient Safety

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A Toolkit for Patients at Risk for Wandering

This toolkit is designed to provide an overview of patients "at risk" for wandering, as well as a variety of interventions to prevent patients from wandering or becoming missing. Think of it as a quick reference you can use to support your efforts.

The suggested interventions range from the most desirable to the most restrictive. It’s impor­tant to consider that each patient is an individual with particular characteristics. A specific measure may work for a particular person, while it may not work for another. Some measures may need to be used at specific times of the day or under certain circumstances.

The best approach is to be flexible and creative. You may want to consider a combina­tion of the suggested interventions. Also remember that a patient may have a variety of disorders to take into consideration.

Cognitive Aids and Resources

Three cognitive aids, including a poster, are available below. There are also a number of resources available online.

At-Risk Patients

Patients are considered “at risk” if, at a mini­mum, they:

  • Are legally committed
  • Have a court-appointed legal guardian
  • Are considered dangerous to self or others
  • Have a history of wandering or being missing
  • Lack cognitive ability (either permanently or temporarily) to make relevant decisions
  • Have physical limitations that increase their risk

At-risk patients can sometimes exhibit the following behavior:

  • Anxiety/stress
  • Confusion
  • Depression
  • Hallucinations/delusions
  • Pacing
  • Wandering
  • Verbalizing intent to leave
  • Restlessness

Interventions

Before providing a number of inter­ventions, here are a few suggestions for communicating with at-risk patients:

  • Speak clearly
  • Use a calm voice
  • Make visual cues to re-enforce your words
  • Make eye contact
  • Get their attention by motion or touch
  • Look for facial signs of understanding
  • Ask yes or no questions and use short simple phrases

First-Degree Interventions

Include diversional activities, such as:

  • Aromatherapy
  • Change of caregiver
  • Familiar objects
  • Family presence
  • Hobbies
  • Pet therapy
  • Reading/music/movies
  • Rocking
  • Social interaction
  • Walks/regular exercise
  • Purposeful focused activities
  • Therapeutic touch

First-degree interventions can also include monitoring activities, such as:

  • One-on-one monitoring
  • Medication review
  • Escorts, sitters
  • Location checks

Second-Degree Interventions

Focus on environmental enhancements:

  • Therapeutic decor (i.e., aquariums, aviaries, plants)
  • Soft door barriers/door knobs

Third-Degree Interventions

Include environmental designs:

  • Location maps
  • Clearly marked signs that can be easily read
  • Clearly marked rooms
  • Lighting change
  • Offer a quiet room
  • Reality orientation board
  • Camouflaged doors (exit signs must remain)

Fourth-Degree Interventions

Emphasize a different set of environmen­tal designs:

  • Locked unit/home/room
  • Door alarms
  • Tracking system
  • Seclusion room

Cognitive Aids

*By clicking on these links, you will leave the Department of Veterans Affairs Web site.

†VA does not endorse and is not responsible for the content of the linked Web site.

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