Supporting Aged Care Nursing Staff to Manage Behavioural and - - PowerPoint PPT Presentation

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Supporting Aged Care Nursing Staff to Manage Behavioural and Psychological Symptoms of Dementia: iSeeBehaviour.

Dr Lisa Clinnick – ACU/Ballarat Health Services Professor Britt Klein - FedUni Associate Professor Andrew Stranieri - FedUni Dr Richard Dazeley - FedUni Professor Suzanne McLaren - FedUni Dr Venki Balasubramanian - FedUni

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25%-50% Rate of NH residents on psychotropic medication (1988) 47.7%

rate of Sydney NH residents receiving psychotropic medication (2006) UK 2009 Dementia Framework submission – “estimated that we are treating 180,000 people with dementia with antipsychotic medication across the country per year. Of these, up to 36,000 will derive some benefit from the treatment” 60%

• f residents receive one

psychotropic medication 37% receive two 11% receive three or more. (1988) 20% The number of residents receiving psychotropic medications who did not have a diagnosis (1994) 2003 Helsinki study 79.9% of residents prescribed psychotropic medications

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Background

• Behavioural and psychological symptoms of dementia

(BPSD), are common in aged care residential facilities.

• Studies report that psychologically-based interventions

can be used successfully to manage BPSD

• identifying and knowing how to apply the most

appropriate behavioural management strategy requires training or expertise.

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Psychotropic medications use

• Side effects of all benzodiazepines include

excessive sedation,

• psychomotor slowing,
• cognitive impairment,
• morning “hang-over” effect,
• ataxia and
• falls
• the overall side effect profile of both typical

and atypical antipsychotics is vast..

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Project Aims:

• to identify an appropriate approach toward the

provision of tools that could be helpful to nurses when making assessments and choosing BPSD intervention strategies when attending to a resident in a short time frame.

• be practically deployed
• encourage a decision maker to exercise discretion
• Developed NBA – Nurses Behavioural Assistant

innovative and sophisticated psychologically-based mobile application and web-based system.

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Analytics Support Decisions

• analytics keeps track of how often a specific

intervention (for each individual BPSD type, per patient) is successful or not.

• Nurses are shown these success scores when

they opt to implement a behavioural intervention.

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Project Design-

• program was implemented at an aged

care facility located in regional Victoria, Australia

• provided with an outline of the research at

two staff training days.

• brainstorming session
• DKAT completed

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Initial Feedback

• Size
• Common BPSD identified
• common interventions identified
• Time

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Resident Assessments

• Selection
• Assessments –
• Saint Louis University Mental Status

Examination (SLUMS).

• Hospital Anxiety and Depression

Scale (HADS).

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Trial Results

• Staff feedback
• It was easy to use.
• It was hard to classify resident by room number vs

name.

• No inclusion of staff member directed behaviours,

this doesn’t fit into a category.

• Possibility of using the app at home to log incidents

after work using a pass code.

• Also, the possibility of including a timeline of

incidents per residents.

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Findings

• behaviours have not coincided with what has

been placed into the resident logs.

• Residents are being provided with medication as

the first response in a number of incidents.

• Nursing staff may not have classified these as

problem behaviours.

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Limitations

• Nursing staff were enthusiastic about the system

concept, however as they have extensive training already they did no use it.

• Small facility was used in this trial
• Small sample of residents for a limited time period.
• A whole facility approach would have overcome

some of the limitations

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Phase 2 - iSeeBehaviour

• Further development using grant funds.
• Enhanced graphics and analytical power.
• Easier use for staff.
• Simpler and more engaging platform.
• Supported with evidence based best practice strategies.
• Nurse Self Care Mindfulness, meditation and stress

management strategies for staff to use on themselves.

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Future

• Conducting RCT of updated iSeeBehaviour platform.
• Enormous support and enthusiasm from Melbourne

based health services and national aged care providers.

• Expect interest to grow further once evaluation has

been conducted.