ARV Woodberry Village Quality Awards - Behaviour Management in the Dementia Specific Unit

Following on from newsletter 44, where we featured an article on the winners of the ARV Quality Awards 2011, this quarter we continue this theme by recognising the staff and management of Woodberry Village, Winston Hills who came second with their Quality Improvement Project based on behaviour management in the Dementia Specific Unit.

The staff at Woodberry Village identified the need to review their practices in the DSU. Primarily their approach was to look at how residents with behaviours were managed.

Early in 2011 a Quality Improvement Team was established comprising of the Care Manager, Care Supervisor, RN, Workplace Trainer as well as inviting outside experts ie: Clinical Nurse Consultants to offer their advise and expertise.

Each member of the team was able to attend regular meetings providing their updates in relation to care of the residents, clinical follow up, staff education and so on.

The goal for the staff at ARV Woodberry Village was to provide a 'holistic' approach to behaviour management, where staff would be resident oriented, not task oriented and focusing on the "well-being" not the "ill-being" of the resident.
By using the PDSA Cycle (Plan, Do, Study and Act), the staff prepared a comprehensive step by step plan identifying opportunities for improvement, causative factors, potential actions to make things better, planning and review. This gave all staff on the committee a clear understanding of their goal.

The committee soon became aware that staff education was necessary and so introduced the "Traffic Light" principal. This requires a "Stop", "Assess", "Continue" approach and along with incorporating a "Step Back Program" staff were educated to provide a more proactive rather than reactive approach, assessing the reasons why a resident's behaviour might change and what if any actions needed to be taken.

An area that was also looked at was the Activity Program. With many residents with Dementia experiencing behaviours later in the day, the activity program was changed to commence at 3 pm. The aim was to assist in stimulating and keeping the residents active, and consequently promote quiet time once the evening meal was completed. Staff hours were also addressed for the morning shift to accommodate these changes.
With many dementia residents admitted without a consultation from a Psycho-geriatrician, the aim was to have mandatory consultations for admission as well as a 2nd weekly review to be conducted if required, or until behaviours settled down.

A Behaviour Management Committee was also established in March 2011 and together with the Quality Improvement Team, conducted second monthly meetings where data was reviewed. New residents were also discussed to evaluate whether new strategies were working and/or additional processes were required.

Results
By the end of the year 95% of all staff were trained in the new processes. Incident data showed there were less episodes of aggression. Incident reporting was improved with staff capturing more detailed information when documenting and reporting the aggressive episode.




Since January 2011, 5 out of 5 new admissions have all been reviewed on arrival by a psycho-geriatrician and 3 out of 3 internal transfers into the DSU have also been seen by a psycho geriatrician.

Changes Introduced
Residents are now reviewed on a regular basis by the psycho-geriatrician, rather than only when there is an issue. The psycho-geriatrician also provides support and conducts staff education sessions. When new residents are admitted to the mainstream or general unit, residents with any degree of dementia are also referred at early admission phase.
Learnings
On reflection we noticed a culture change amongst staff where they began to take on board the changes introduced and were able to identify better ways to look after the residents and keep them settled to manage their behaviours. It was interesting that one of our learning's that became apparent during the process was to also realise that not all staff are suited to working in the Dementia Unit.