Door Decals for Wayfinding and Redirection: A Quality Improvement Project Involving the Use of Clinical Real-Time Location Systems for Evaluation of Environmental Design Changes.

Background and Objectives: Environmental design modifications are important non-pharmacological interventions for people with dementia in older adult residential care, but their effects are difficult to measure objectively. In this paper, we present the assessment of the impact of door decals installed on patient rooms, offices, and exit doors on patient movements as an example of the uses of location data in evaluating environmental design interventions. Research Design and Methods: We undertook a quality improvement project in an inpatient specialized dementia unit using de-identified data from a clinical location monitoring system from 79 individuals with dementia admitted over time to 15 patient rooms to measure patient movements. In the first phase, decals were applied to 1 office and 6 patient room doors, and doors with and without decals were compared. In the second phase, patient movements were compared before and after a decal was applied to the remaining exit, office, and 9 patient doors. Main outcomes of interest were the number of daily approaches to concealed doors and daily approaches and entrances to patients' own and others' rooms. Results: Using location data, we identified a significant reduction in the number of approaches to and dwell time at office doors and exits. No differences were found in patient movements in relation to their own or others' rooms in either phase, although patients assigned a room with a decal tended to approach others' rooms with decals less often than those with a plain door. Discussion and Implications: Door decals successfully reduced patient contact with staff-only doors and exits but did not have a large impact on patient movement with respect to wayfinding. Location tracking systems provide an important opportunity to evaluate the impact of design interventions in situ in specific older adult care contexts.