G2 Sandra Psiurski Behavior Reduction Across the Spectrum for Seniors (B.R.A.S.S.)
Transcript of G2 Sandra Psiurski Behavior Reduction Across the Spectrum for Seniors (B.R.A.S.S.)
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Behavior Reduction Across the Spectrum for Seniors (B.R.A.S.S.)
Sandra Psiurski, RPC, RPN Interior Health Authority February 2013
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AIM To increase frontline residential staff confidence
and ability to manage residents identified as belonging to a special population, who present with behavioural challenges which
– interfere with or inhibit others quality of life – occur repeatedly – places the resident or others at risk for injury – does not respond to routine interventions. – exhaust staff
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The case that sparked the start of B.R.A.S.S.
...Looking for that magical elixir to cure our elderly woman!
(Risperdal, Loxapine, Trazodone, Ativan, Valproic, Zopiclone, mixed with a little Seroquel dust...)
over 5 days......
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How are behaviors viewed? • CURRENT APPROACH: • Medicate the behavior • Admit to hospital
• WHY? • Fear • Personalizing behavior as action against us
• NEW FOCUS • Understand behavior is communication • Manage resident in the residential facility
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WHY BUILDING CONFIDENCE & CAPABILITY IS IMPORTANT
IF COSTS WERE CALCULATED AS: Management - Outside counsel - Debriefing - Recruiting and training new staff - MOUNTAINS OF PAPERWORK CONSEQUENCES FOR NOT BUILDING CONFIDENCE...
• appeasing, calming, counseling or disciplining • reorganizing departments, reassigning staff • managing burnout, decreased commitment, and increased distress • addressing the media
ORGANIZATION – YOU LOSE STAFF BY DEFLATION OR DEFECTION - Impaired ability to attract the brightest and the best to work with you. •Adapted from Sutton, Robert (2007) “No Asshole Rule”.
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Managing Behaviours
Features of successful management plans – Tailored to individual's needs – Explicit goals, clearly formulated – Realistic and prioritized goals – Long-term and short term goals – Attempt to reach shared expectations – Consistent and tolerant approach – Multi-disciplinary
Davison, Sophie A (2002)
3/5/2013 6
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Addressing Behaviors For many staff, addressing behaviors presented by
our seniors seems as foreign as understanding shark behavior –
The fear is of the unknown Providing education has created pockets of success What gaps do we need to address to create spread
throughout the organization?
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PROFICIENCY
You didn’t become proficient overnight, in one day, in one training, in an online session... it took repetition, making mistakes, and having support to help you improve.
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CREATE A TIMELINE
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Born 1929 – Age 83
Raised during the Dirty 30’s, dustbowl, poverty
Fought in the (forgotten) Korean War 1950 – 1953 Aged 21 - 23
Was a young adult, got married, Canada opened first TV station, TV dinners arrived, Drive in diners and theaters were the place to go…cool cars….
1940 – 1965 period of rebellion, lawlessness, prohibition, rationing didn’t end until 1954
Raised children through the 50’s & 60’s , Dr. Spock, self – esteem, different cultural focus
TV SHOWS – MORE THAN JOHN WAYNE! MUSIC – ROCK N ROLL – MORE THAN ELVIS!
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You can’t know where you are going if you don’t know where you’ve been
• WE DON’T HAVE ANYONE WHO CAN PROVIDE US WITH HISTORY
• Hmmm… do what an archaeologist does – DIG FOR IT
The Archaelogical Dig 11
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PILOTS
• Cottonwoods, Kelowna is an IHA Owned and operated, 254 residential care beds
• Hamlets of Penticton is a 103 residential care beds with 75 beds funded through IHA.
• Village by the station is a private partner with 100 residential care beds total: (4) 10 bed dementia cottages, 60 complex care beds
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SPECIAL POPULATIONS CONSULTATION EXPANDED PROJECT SCOPE:
Consultation for all Interior Health and their private contracted residential facilities
A full time consultant will be hired
The BRASS project will also continue for a few more months to allow quantitative data collection
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REFERRAL NEEDS Short term assistance: <5 contacts with facility Assist with care plan development
Connect with community services available to the facility Provide education Long term assistance: More routine contact daily, weekly or biweekly for a total of >5 contacts Staff education and support Care Plan development Possible site visits Assist in collaboration with community resources Family contact and collaboration
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Types of referrals
~ 25% of referrals < 65
BEHAVIOR ISSUE RELATED TO: NUMBER DEMENTIA with Aggression 18 Acquired Brain Injury (CVA most common) 5 Personality Disorder/Components 15 Mental Illness (Depression, Anxiety, etc) 5 Neurological (Huntington, ALS, etc) 2 End of Life (EOL) 3 Developmental with behavior 1 Deceased before consult completion 1 Cancelled 3 TOTAL REFERRALS (Aug 2013 – Feb 2013) 53
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DISCOVERIES • Every area of the IH Region has different
mandates for mental health services to residential facilities
• Skill set and mind set are varied from facility to facility.
• Skills need to improve in writing clear, concise care plans - too many are vague and are not individualized to be relevant to the resident
• Staff are eager to learn and will follow the process if supported by their managers
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OVERALL COMMENTS • Presence of a consultant has made a difference in
the region • Staff feel hope knowing someone is here to help
them • Staff confidence levels have increased • Educational presentations have been well
received and requested more widely for acute, community and family caregiver groups
• Requests for consultation from community agencies and acute systems
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BRASS SUCCESS • Based on the comments we have received we
are on our way to meeting the aim to improve confidence and capability to address behavioral challenges within our residential facilities
• BRASS project will be extended to allow collection of more quantitative data
• A special populations consultant will be hired to continue the work that was started by this project.
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Questions
Sandy P Sandra Psiurski, RPC RPN Interior Health Authority 550 Carmi Avenue Penticton, BC V2A 3G6 250-492-4000 X 2684 250-488-3429 [email protected]