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atients with cognitive impairments pose many challenges to healthcare facilities. Among these challenges is security. If your facility has residents who wander, security is a major concern. Not only do you want to know where your wandering and at-risk residents are at all times, but you want to keep them out of harms way without impacting their quality of life and without physical restraints. Here's a glance at the types of wandering technology available today and what you should look for when selecting a wandering system.

What's Out There
       Look for a monitoring system designed with the residents' freedom of movement and quality of life in mind. These systems allow the facility to monitor certain areas for wandering residents. Wandering systems can be simple or complex depending on the facility size and number of residents, whether you need to monitor a few patients or a hundred. The range in complexity can be as simple as a motion sensor that sounds an alarm when a resident approaches an exit to a system that monitors multiple facilities or facilities that have several floors with multiple exits, stairwells, elevators, or outdoor areas.
       With more complex systems, residents wear transmitters around their ankles or wrists. Advances in the design of transmitters have produced transmitters that are unobtrusive. Some transmitters resemble watches, and some are tearproof and waterproof. When the monitored resident approaches a monitored area, the resident will be recognized, and at this point, an alarm will sound, a silent alarm will activate and caregivers will be notified, or the door will lock. The type of alert the caregivers receive is customizable in many monitoring systems. In some of the simpler systems, an alarm will sound when a resident approaches a monitored exit or when a resident exits a monitored doorway. In more complex systems, a silent alert will notify caregivers of the wandering incident and the doorway will be temporarily locked. The benefit of a silent alarm is that it does not disturb residents by maintaining a peaceful, home-like environment. In a silent system, when a resident attempts to exit a monitored exit, caregivers will be alerted either through a central computer or through beepers.
       Notification can be customized in many systems as well. In some systems, when a patient exits a monitored doorway, a display at the point of exit will show the resident identification number. Another feature is the transmission of the specifics of the wandering event to individual nursing beepers or pagers. Some systems will display the patient's id, the exit from which the resident exited, and the time of the event on individual beepers or pagers. An option is to have the wandering specifics not only sent to individual pagers but also sent to a central computer system where the wandering events can be recorded and tracked. Nursing response time can also be tracked along with wandering trends.
       Another feature to look for is a low-battery alert and a back-up system should a battery run down.

What to Look For
       In shopping around for the best the industry has to offer, here are a few things to keep in mind:
       Installation: Regardless of the technology you choose, seamless installation is a must. Ask the company what the installation entails. Some systems can be installed directly by the facility via detailed instructions provided by the company or via phone assistance.
       Integration: Can the wandering system be integrated with the already existing nurse call system or pagers? What about software and hardware? Tracking and recording wandering events and trends and nursing response time are valuable features, but will you need to buy a central computer unit from the company, or will it integrate with the facility's preexisting system?
       Product support: Ask the company what type of technical support is offered. Technical assistance via telephone 24 hours a day seven days a week is a service most companies offer. In addition, some companies have service representatives available at all times to accommodate your needs. Look for companies who have representatives who will evaluate the facility's needs, provide on-site product demonstrations, offer staff training, and provide equipment installation, maintenance, and repair.
       Ongoing research and development: Ask the company if research is being conducted on an ongoing basis to advance the technology. Also, if the research is ongoing, and upgrades to your system will become available at a later date, ask the company if the upgrades will be provided free of charge.
       Financing: Shop around for a company that is willing to work with your financial capabilities. Some companies offer a payment plan for their products and services.
       Warranty: A warranty is a critical service that all companies should provide. Warranties will range in length anywhere from one year to several years. In addition, if an element of the system breaks, how easy will it be to get a replacement? If a patient transmitter breaks, will the company ship a replacement overnight, free of charge?
       Accommodation: A selling point for some facilities will be how accommodating the system is. Steer clear of a "one size fits all" system if your facility will be expanding in size or resident occupancy. Should the facility need to expand in size in the future or grow in number of patients, will you be able to expand the system? Will it be simple to integrate additional exit points? For example, can you add an elevator or stairway after the system has been installed? Can you add features at a later date?
       Ease of use: How easy is the system to use? Can staff quickly clear and reset the alarm? Is it simple for a caregiver to bypass an alarm, should he or she need to escort a resident through a monitored area? Ask the company to provide references and speak with contacts from other facilities that have implemented their systems.
       Maintenance: Can maintenance staff within the facility maintain the system? Or does a trained professional from the company have to be contacted in a maintenance situation?

Supporting Your Technology
       It is important to remember that wandering technology exists to support staff's efforts to maintain residents' safety, security, and well being rather than replace them. A wandering system will only be as effective as care within the facility. Before you approach the difficult task of finding a system that fits the needs of your facility and residents, make sure you have the support of everyone involved. Without a full commitment from all those involved, including family members, a wandering system will not be successful.