Dementia Unit Manager Tip of The Day:
Conduct Daily Environmental Rounds

If you are not currently conducting environmental rounds, you should
implement environmental rounds on a daily basis. This involves touring your entire unit
daily, day room, bedrooms, bathrooms, community bathrooms, hallways, closets, etc.
Document everything that is in need of repair or broken, cluttered or messy, dirty and
just time to discard. Submit your list of repairs to the Maintenance Director, Director of
Environmental Services and cc your Administrator.

As you are touring the bed rooms and bathrooms, open all closets and drawers.
Remove anything that is harmful or spoiled such as old food, razor blades, dirty tooth
brushes, open bottles of nail polish remover, etc.

Look for health care products that are left open. As most products are harmful if
ingested. Additionally if you see padding of beds, hoarding of plastic bags, diapers,
towels by the Nursing Assistants, this also has to be addressed immediately. Not only
is it wasteful for the facility but also dangerous for the resident.  Consider keeping all
health care products in a sealed Tupperware container with the resident name labeled
on the container and bringing the container only at the time ADL’s are rendered. These
containers can be kept in a locked hallway closet or behind the nurse’s station in a
locked area. Or provide locked drawers in resident rooms to contain their health care
products. Across the nation, dementia residents who wander into other rooms are
swallowing health care products that have been left out during ADL care. This is an
accident that can be avoided.

Nurse’s stations should be neat and organized and resident access controlled. The
Nurse’s closets and kitchens locked at all times.   

Environment also refers to noise, lighting, temperature. Be aware of issues concerning
lighting (too bright or dim), room temperature too cold or too hot, and the unit very noisy.
If it is a noisy unit, conduct a noise study for one week. Write down all the noises and
then meet as a team to see which specific noises can be eliminated or fixed. For
example, staff yelling down the hallway can be addressed, squeaky med cart wheels
can be oiled, unit phones ringing loudly can be toned down and replaced with chimes,
TV and radio on at the same time can be turned off and call bells not being answered
immediately can be  answered by all staff quicker.

Provide a copy of the environmental rounds with a list of repairs or sanitary issues to
Housekeeping, maintenance and cc the administrator. Give a required date that repairs
must be completed by and date the form must be returned to you by. In most cases, if a
repair does not pose a hazard than a few days turnaround time is acceptable. Once
these are returned from the department heads, keep the completed environmental
rounds forms in a notebook.

Daily meet with your staff and have a brief stand up meetings and show them the items
that were found in resident rooms and common areas that could pose a hazard. Always
state your expectations for the unit. Clean, organized and peaceful. All rooms, closets
and drawers should be neat and organized. Day room chairs should always be pushed
into the tables. Something as simple as pushing in the chairs can avoid a cluttered
obstacle course look. Hallways should not look like an obstacle course with dirty linen
carts, housekeeping carts and activity carts, etc. Cart should be on one side of the
hallway. Have you staff always sign in to these stand up meetings and document what
was discussed.

Observe activity staff and their programs and the use of potentially harmful activity
products or health care products such as nail polish remover.  Address any areas of
concern. Be sure to have MSDS for all products coming onto the unit.

Include in your newsletter anything that families should be aware of. Remind them of
the acceptable health care products for the resident’s rooms, and why some products
can be harmful if ingested.

As different holidays approach, remind the families when they decorate the resident
rooms, what are acceptable decorations and what poses a threat. In many states, you
cannot use extension cords. Some families may decorate with items that look real, like
artificial fruit and plastic candy. Be sure to explain the hazards of using these items and
why they are not allowed on the unit. Additionally, you should make sure the families are
aware of potentially dangerous plants that if ingested could make the resident sick.
Provide a list of acceptable plants for resident rooms.

Require that all shifts check the Wander Guards and any other safety measures you put
into place. In some instances, this is done weekly but you are leaving yourself and the
facility open to a catastrophic event. The resident may elope. What if the battery died
within the 7 days? All safety systems and devices should be checked every shift.         

The time the Dementia Unit Manager spends conducting environmental rounds is an
important aspect of security and the Dementia Unit Managers job. The Dementia Unit
Manager is being pro active in insuring the safety of the residents placed in her charge.
If you are interested in Certified Dementia Care Manager certification and seminar,
please see the list of the upcoming 2010 dates contained in the newsletter.
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Sandra Stimson has
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