Safe to wander - Mental Welfare Commission for Scotland

7Assessment of riskAny assessment must includeanalysis of the risk that isbeing presented. This mustfocus on the risk to theindividual, not the organisationor care facility. Assessmentshould always take the viewsof the individual, formal carersand involved relatives intoaccount. There should be acareful evaluation of the riskthat is presented and thelikelihood of that occurring.The risk to the individual ofany proposed interventionshould also be discussedand this would includepsychological as well asphysical safety concerns.Care establishments shouldhave written policies on careplanning and risk assessmentthat take into account theperson’s need to exerciseand move freely.Alternatives to wanderingtechnologyBefore considering the useof wandering technologythere should be an appraisalof the interventions thathave been tried to date.This should form part ofthe assessment process.People with dementia needappropriate stimulation andactivity. Individual care plansmust reflect this and willbenefit from input from askilled occupationaltherapist. A person withdementia who finds him orherself in an understimulatingenvironment, maywell explore in an attempt tofind something moreinteresting or meaningful todo. It would be whollyinappropriate to use atechnology solution for thisbehaviour, unless greatattention is paid toappropriate, person centredoccupation and stimulation.The importance of dementiafriendlydesign, including thecreative use of outdoorspace should not beunderestimated althoughthere will obviously bephysical limitations in older,non-purpose built units.Ideally, buildings shouldprovide open access to safeoutdoor space. The internalenvironment must containdestinations that are ofinterest. Long corridorsleading to locked exit doorsmust be avoided.Small changes in practiceand environments can havesuccessful outcomes. Theimportance of exerciseshould be taken into accountand incorporated into the careplan as appropriate.The use of cloth panels toconceal doors or door knobs(which can be described as‘subjective barriers’ towandering in that theyappear as an obstruction onlyto those who are cognitivelyimpaired) could offer a lessrestrictive option than alocked door.Another alternative towandering technologyis the adaptation of nursingobservation policies to meetthe needs of the individualflexibly and when mostnecessary. Many individualsrequire increased levels ofobservation only at particulartimes of day and night,rather than having fixedobservation levels.