Hospital Alert and Protocols Protect Dementia Patients


By Debra Goldie Jones

Five years ago, an Englishman named Norman McNamara was diagnosed with dementia at the age of 50. While struggling to adjust, he experienced problems, including a shopkeeper who treated him rudely. The feeling was so stinging and staggering, he vowed to change the way people see and treat dementia. His determination gave birth to the Purple Angel.

Now a group of Geriatric Care Managers is hoping to put Purple Angels in Dallas-area hospitals.

Like the Fall Risk symbol, the Purple Angel identifies certain kinds of patients to hospital staff without using words, in compliance with HIPAA. If cognitive deficiency or altered mental status (dementia, delirium, traumatic brain injury, etc.) is discovered upon admission, a Purple Angel sticker is applied to the wristband and a magnetic sign is placed on the patient’s door. This alerts staff to do a cognitive screening test when gathering data and comply with specific communication and care protocols.

Carole Larkin, a Dementia Consultant, is leading the Dallas group’s effort. She says Purple Angel designees can’t be treated the same as someone who is cognitively normal. “You cannot automatically assume their answers will always be true,” she warns. “If possible, get permission from the patient to verify responses with a third party who knows their healthcare situation.”

The Purple Angel magnet on the patient’s door provides step-by-step instructions such as how to enter the room:

Take a deep breath and center yourself, then knock hard three times
only. Wait for the invitation to come in. If no response, knock three times hard again. If still no response, walk in. If patient is asleep, knock three times only to wake them up. Do not touch!

There are other directives for how to start a conversation, explain a procedure, get a patient to perform a task and gather information from a third party while in the patient’s presence. The language is calm, direct, firm and friendly.

If the patient becomes upset with the repetition say to them,
“I apologize. These are our rules,” and then give them a big smile.
No long explanations and no arguments.

The Purple Angel program and brief training is available at no charge. Using these protocols has multiple benefits for the hospital such as reducing the amount of antipsychotics used to quell undesirable behavior. More cooperation and compliance with hospital procedures means less time, effort and manpower needed to manage agitation. Nurses or social workers can lower family anxiety by educating and providing cognitive care resources. More data collection promotes targeted diagnosis and treatment and identifies potential candidates for clinical trials. It also supports a more precise discharge plan reducing the possibility of readmission within 30 days.

For more information about the Purple Angel Initiative, please contact: Carole Larkin at


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