Shawn Applegarth

A Framework for Managing Wandering and Preventing Elopement

Purpose of the Study: A framework aids choice of interventions to manage wandering and prevent elopement in consideration of associated risks and mobility needs of wanderers. Design and Methods: A literature review, together with research results, published wandering tools, clinical reports, author clinical experience, and consensus-based judgments was used to build a decision-making framework. Results: Referencing a published definition of wandering and originating a clinical description of problematic wandering, authors introduce a framework comprising (1) wandering and related behaviors; (2) goals of wandering-specific care, (3) interpersonally, technologically, and policy-mediated wandering interventions, and (4) estimates of relative frequencies of wandering behaviors, magnitudes of elopement risk, and restrictiveness of strategies. Implications: Safeguarding wanderers from elopement risk is rendered person-centered and humane when goals of care guide intervention choice. Despite limitations, a reasoned, systematized approach to wandering management provides a basis for tailoring a specialized program of care. The need for framework refinement and related research is emphasized.

An experimental method for detecting blood splatter from retractable phlebotomy and intravascular devices

BACKGROUND This study was designed to evaluate the safety of retractable intravascular devices in terms of their potential to produce blood splatter. A method for measuring this blood splatter designed by the research team was used to evaluate 3 specific intravascular devices. METHODS Scientific filters were positioned around the retraction mechanisms of the devices and weighed with an analytical scale, both before and after activation, in a simulated vein containing mock venous blood. The difference in filter mass was used as the primary unit of analysis to detect blood splatter. In addition, the filters were visually inspected for the presence or absence of blood. RESULTS A paired t-test revealed significant differences in the prefilter and postfilter groups for 2 of the 3 devices tested (P < .0001). In addition, visible blood was detected on 23% to 40% of the scientific filters for 2 of the devices. CONCLUSIONS Our findings indicate a potential for bloodborne pathogen exposure with the use of intravascular devices with a retractable mechanism. This experiment may serve as a model in the design and implementation of future sharps device evaluation protocols to validate the threat of bloodborne pathogen exposure.

Contribution of a winged phlebotomy device design to blood splatter.

BACKGROUND Despite a proliferation of phlebotomy devices with engineered sharps injury protection (ESIP), the impact of various winged device designs on blood splatter occurring during venipuncture procedures has not been explored. OBJECTIVES To evaluate the potential for blood splatter of 6 designs of winged phlebotomy devices. DESIGN A laboratory-based device evaluation without human subjects, using a simulated patient venous system. METHODS We evaluated 18 winged phlebotomy devices of 6 device designs by Terumo, BD Vacutainer (2 designs), Greiner, Smith Medical, and Kendall (designated A-F, respectively). Scientific filters were positioned around the devices and weighed before and after venipuncture was performed. Visible blood on filters, exam gloves, and devices and measurable blood splatter were the primary units of analysis. RESULTS The percentages of devices and gloves with visible blood on them and filters with measurable blood splatter ranged from 0% to 20%. There was a statistically significant association between device design and visible blood on devices ([Formula: see text]) and between device design and filters with measurable blood splatter ([Formula: see text]), but not between device design and visible blood on gloves. A wide range of associations were demonstrated between device design and visible blood on gloves or devices and incidence of blood splatter. CONCLUSIONS The results of this evaluation suggest that winged phlebotomy devices with ESIP may produce blood splatter during venipuncture. Reinforcing the importance of eye protection and developing a methodology to assess ocular exposure to blood splatter are major implications for healthcare personnel who use these devices. Future studies should focus on evaluating different designs of intravascular devices (intravenous catheters, other phlebotomy devices) for blood splatter.

AUTOMATED AND MANUAL MEASUREMENT OF THE FORCES REQUIRED TO USE RETRACTABLE INTRAMUSCULAR SYRINGES

The purpose of this study is to compare the forces required to activate retractable intramuscular safety syringes using healthcare worker researchers vs. a computer-controlled system. The force required to activate three commercially available retractable safety syringes was measured using two methods: (1) a manually-operated digital force gauge (DFG) and (2) a completely automatic computer-controlled universal testing machine (UTM). To simulate the clinical setting, saline was drawn into the barrel of each syringe before testing and ejected either during or before force measurements were recorded. There was a statistically significant difference in activation force between the two researchers and the UTM (p < 0.001) for 2/3 devices tested. There was a wide discrepancy in activation forces between the three brands of devices regardless of the testing method. The results imply that a human element exists in the injection process that cannot be discounted. Future studies should explore the sum of forces involved with an injection, the notion of training HCWs to modify these forces, and the relationship between force and occupationally-acquired hand and wrist injuries. Minimizing the impact on the healthcare worker who may give hundreds of injections per day with these syringes should be a priority for those involved in the health field.

Australian family and professional carer attitudes to locator technologies used to manage wandering-related elopement and getting lost associated with dementia

S FOR THE NATIONAL DEMENTIA RESEARCH FORUM SEPTEMBER 24–25, 2009 SYDNEY, AUSTRALIA 1 AUSTRALIAN FAMILY AND PROFESSIONAL CARER ATTITUDES TO LOCATOR TECHNOLOGIES USED TO MANAGE WANDERING-RELATED ELOPEMENT AND GETTING LOST ASSOCIATED WITH DEMENTIA E. Beattie, J. McCrow, W. Kearns, S. Applegarth, Queensland University of Technology, Brisbane, QLD, Australia; University of South Florida, Tampa, FL, USA; James A. Haley Veterans Administration Hospital, Tampa, FL, USA Background: People with dementia (PwD) who wander risk injury, getting lost, and death. Technological development supports devices that enable PwD to access safe areas while limiting unsafe or unaccompanied locomoting. The purpose of this study was to explore Australian stakeholder attitudes about these technologies and compare outcomes with those from a previous U.S. study. Methods: Nine semistructured focus group sessions (N 1⁄4 65) were held with home health care workers, nurses, cognitively intact nursing home residents, family carers of PwD, allied health care professionals, and police. Initially, participants received information on alarm and locator technologies and then discussed device design, functional elements (eg, size, weight, body placement, and reliability), cost, and social implications. Results: Participants saw locator devices as a viable option for possible rapid recovery of lost PwD but not a foolproof solution. For caregivers, device management and cost were major issues, consistent with U.S. attitudes. Employed carers and police were concerned about the fit of technologies with family carer preferences and public policy relating to location and recovery practices. Cognitively intact nursing home residents consistently raised the issues of the burden of care involved in wandering management for both staff and other residents. All participants were keenly aware of ethical issues related to technologies and the need for continued personal surveillance of PwD who have compromised environmental mastery. Conclusions: Australian participants, as in the U.S. study, supported the use of technology to manage wandering behavior in PwD but raised a number of important ethical and practical issues requiring further discussion. 2 ON-ROAD ASSESSMENT FOR PEOPLE WITH DEMENTIA: HOW TO ACHIEVE THE GOLDILOCKS POINT (NOT TOO EASY, NOT TOO HARD, BUT JUST RIGHT) A. Berndt, E. May, P. Darzins, University of South Australia, Adelaide, SA, Australia; Monash University, Melbourne, VIC, Australia Background: Dementia syndromes impair cognitive, visuospatial abilities and judgment required for safe driving. When driving task demands exceed the capacity, driving failure occurs. On-road assessments should be designed to assess the task-capacity nexus to avoid erroneous test outcomes within local road environments. Methods: Drivers were recruited through a memory clinic: 86 men and 29 women; aged 48 to 88 years; mean, 75 years (standard deviation, 6.7); Mini-mental score range, 10 to 30; mean, 23 (standard deviation, 3.7). On-road assessments used a standard test route in dual control vehicles, with two observers. Driver performance was operationalized by 12 defined error categories. The test route included multiple ‘‘traps,’’ places where drivers could easily make errors, such as stop-sign controlled intersections. Results: The error and task-item relationships of the on-road driving performance of 115 drivers (50 pass and 65 fail) were analyzed. Drivers with fewer and less severe errors had higher cognitive scores (P 1⁄4 .0001). As expected, common traps resulted in common errors. Critical errors were less common. Critical errors occurred in both complex and simple traffic situations. Critical errors were not related to driving fatigue during the test. Conclusions: Design of on-road assessments influences driver errors. Overall driving performance must be judged in relation to the on-road assessment characteristics. Adequate samples of task items are needed. Weighting of scores should account for errors ’’forced’’ by the design (eg, being ’’caught’’ by the traps) versus ’’unforced’’ errors that result from poor driving habits or from critical dementia-related driving failure. 3 CHALLENGES TO IMPLEMENTING AN EVIDENCE-BASED PARTNERSHIP MODEL IN AN AUSTRALIAN RESIDENTIAL CARE SETTING M. Bramble, W. Moyle, D. Shum, Griffith University, Brisbane, QLD, Australia Background: This partial replication study tested the effects of a best practice model of dementia care, the Family Involvement in Care (FIC) intervention, in an Australian residential care setting. Originally trialled and implemented in North America with successful outcomes, this intervention sought to establish therapeutic partnerships between family (n1⁄4 30) and staff caregivers (n1⁄4 31). Study findings highlight the critical need for research to be conducted in a practice environment in which there is support at the policy and management level for skilled nursing staff and managers to lead and support the implementation of the research. Methods: This controlled trial study used a mixed-method sequential design to test the success of the partnership intervention and provide evidence of its effectiveness in the Australian clinical setting. The intervention was empirically and theoretically driven by using person-environment and role theory to examine improvement in knowledge, stress, and satisfaction outcomes for families and staff. Results: Postintervention interviews provided strong evidence of family support for the partnership concept. However, the intervention was not successful in achieving beneficial outcomes, with post-test family measures reflecting decreased satisfaction with management effectiveness [t (29) 1⁄4 2.64, P <. 05] and staff caregivers [t (55) 1⁄4 2.18, P <. 05] compared with the control site. Conclusions: The major barrier to success was lack of clinical leadership and staff trained and committed to sustain the partnership. Successful implementation of care-directed interventions requires attention to staff recruitment and investment in education to build professional capacity and staff skills in the specialist area of dementia care. 1552-5260/09/

Technology to promote safe mobility in the elderly

– see front matter 2009 The Alzheimer’s Association. All rig Alzheimer’s & Dementia 5 (2009) e10–e17 4 THE HOSPITAL DEMENTIA SERVICES PROJECT D. Gibson, B. Draper, R. Karmel, A. Peut, P. Anderson, G. Brien, I. Seebus, University of Canberra, Canberra, ACT, Australia; University of New South Wales, Sydney, NSW, Australia; Australian Institute of Health and Welfare, Canberra, ACT, Australia Background: The acute care of people with dementia in hospital is complex, with prolonged length of stay, increased risk of delirium, and a strong association with entry into residential aged care (RAC) after discharge. It is hypothesized that hospitals with resources and policies that focus on quality