Safe to wander - Mental Welfare Commission for Scotland

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4On no account shouldtechnology be usedmerely to save on thecost of appropriatestaffing.General principlesin considering the useof new technologiesThe key to best managementof wandering behaviour is toallow the person to walk freelyand to destinations of interestwithout subjecting the personto unnecessary or causingunnecessary distress. Theuse of technology maycontribute to this, but only inconjunction with good designof the living environment,stimulation, meaningfulactivity and appropriatelytrained care-givers.A person for whom the useof wandering technologyis being considered is likelyto lack capacity in relationto decisions about its use,although this should not beassumed. Where capacityis lacking, it is important thatthe principles of the Adultswith Incapacity (Scotland)Act 2000 are applied indecision making:The intervention mustprovide a benefit that cannototherwise be achievedWhat will the benefit ofthe technology be to theindividual? If usedappropriately the benefitmay be improved personalsafety, increased dignity,independence and senseof freedom. It may reducethe need for obtrusive levelsof observation that could bedistressing for the individual.There might be drawbacks tothe use of such technology.Apart from unnecessaryrestriction of freedom,(see below) it may providea false sense of security.The person may travel withinan apparently safe area butmay not be alert to significantrisks within that area. Also,the person may leave thesafe area and suffer harmbefore care-givers canrespond to an alert. Theuse of new technology mayreduce personal contactwith care-givers and this isunlikely to benefit the person.Technology is no substitutefor appropriate levels ofpersonal care and humaninteraction. On no accountshould technology be usedmerely to save on the costof appropriate staffing.The intervention must be theleast restrictive in relation tothe person’s freedom in orderto achieve the desired benefitWill the technology resultin the least restrictionconsistent with the person’sdignity, safety andindependence? There islikely to be a tensionbetween protection andsafety, versus privacy anddignity. Technology mayallow the person morefreedom than locking doorsor having a member of staffwatch the person at all times.However if the person oftenhas to be retrieved andreturned to the place ofresidence, it may resultin increased distress orpublic ridicule.The past and present wishesof the person must be takeninto accountCare-givers should notassume that the personlacks capacity in relationto wandering technology.People whose cognitive abilityfluctuates may be capable ofstating their wishes to be safeduring periods of increasedconfusion and can participatefully in decisions. Even whenthe person appears to lackcapacity, care-givers mustmake every effort possible
5to discuss such risks and tohelp the person to understandthe benefits of technologysolutions. Care-givers shouldmake a careful record ofsuch discussions includingwhether the person agreesor disagrees with the useof technology. This must beapproached with sensitivityand only after the person hashad time to come to termswith his or her diagnosisand its implications.The views of relevant othersshould be taken into accountA wide range of people willhave valuable roles to playin the decision on whetherto use wandering technology,including:• Nearest and close relativesand friends will knowthe person best andcan provide valuableinformation about his/herlife. This may be crucial inunderstanding the person’sbehaviour. They will alsohave views about risks anddignity and these shouldbe taken into account.• A welfare attorney orguardian with powersover the person’s welfaremay have the authorityto consent to the useof wandering technology.Even where a specificpower is not included inthese granted these mayinclude decisions onthe person’s place ofresidence, which may beaffected by the potentialuse of technology. In suchcases it is important toconsult such a person onthe use of technology.• Professional carers willhave experience inmanaging wanderingbehaviour, in particular theiradvice on environmentaldesign or modificationsand assessment of riskwill aid the decisionmaking process.The intervention shouldencourage the person to useexisting skills and developnew onesThis principle is to beobserved by attorneys,guardians and managersof care establishments,and represents good practicefor anyone involved in theperson’s care. If the useof technology to managewandering behaviourincreases the opportunityfor the person to use existingskills and to develop newones, then it merits seriousconsideration.Considering the use ofwandering technology:assessment and careplanningPrior to introducing anywandering technologysystem there should becareful physical andpsychological assessmentto eliminate any reversiblecause of the wanderingbehaviour. This assessmentwould involve analysing whatis actually happening, whenit is happening, what triggersthe behaviour and whatintervention helps.• Physical assessmentAny physical assessmentsshould be multi-disciplinaryand should include:Medication reviewMany medications for bothphysical and psychiatricconditions have side-effectswhich can include motorrestlessness, confusion andconstipation amongst others.All of these side-effectscan contribute to thedevelopment of worseningwandering behaviour andmedications should beregularly reviewed by themedical practitioner(particularly those suppliedfor the treatment of anxiety,depression and insomnia).
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Safe to wander - Mental Welfare Commission for Scotland

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