Reducing Aggressive Behaviours at MACS

Multicultural Aged Care Services - Geelong (MACS) aims to provide excellence in care, to meet the diverse needs of the multicultural community in the Geelong region.

It is widely held that behaviours of concern displayed by residents, such as, wandering, agitation, verbal aggression and physical aggression, can often be a result of, or aggravated by, unmet needs. Here at MACS we have discovered that identifying unmet needs and addressing them appropriately is an effective behaviour management strategy, which incorporates individual personal assessment, information gathering, application of interventions, continuous review of the effectiveness of the strategy and reassessment if required.

MACS Behaviour Management portfolio is coordinated by one RN, who has had specific dementia and behaviour management training. In addition, this RN is specifically trained in concept mapping and analysis. In house and external dementia and behaviour management education and training has been encouraged and supported for all care staff and many other staff from other departments within our organisation.

Concept mapping is the tool used by MACS to gather, sort and analyse important information about individual residents. Formal assessments include all/any of the following:

• A cognitive assessment which may include mental state examination and RUDAS assessment (for residents for whom English is not a first language)
• Depression Scale
• Regular documentation of behaviours and behaviour changes in resident's progress notes by attending staff
• Creation and completion of a behaviour chart that identifies time, type, duration and outcome of specific behaviours
• Sleep chart (to ascertain if challenging behaviours occur during sleeping hours as relevant
• Full continence assessment
• Medical consultation
• Discussion with resident / family / significant others
• Completion of relevant forms that identify any specific accidents and / or incidents (involving the resident and / or others)
• Pain assessment

When it has been identified that behaviour management intervention is required for a resident, the RN commences a concept map. A large piece of butcher's paper is displayed in staff work areas so that staff can write any information on the map under existing headings. Staff members from all departments have been educated in-house on how to contribute to the concept map. Our multilingual staff play a very important role here, as they are able gain information which is often difficult for English speaking staff to obtain. Relevant information from the above list of assessments is also incorporated into the map.

The behaviour management RN also gathers information from other significant people - family, friends and healthcare worker and enters information. A behaviour management plan is developed using all the information gathered. The behaviour management care plan aims to address any unmet needs e.g. language, cultural values, pain, continence issues or mental health issues, as well as provide individual strategies to enhance quality of life.

To ensure consistency of care and interventions, the care plan is communicated to care staff and discussed at formal handovers at the completion and commencement of each shift. Interventions and strategies are also communicated to staff of other departments who have direct contact with the resident. Lifestyle, food services, environmental and administration staff all contribute to our resident's quality of life. Feedback from all staff is encouraged through informal discussions, incident forms or entry into progress notes.

The effectiveness of the care plan is reviewed on a regular basis (monthly and as required), and re-assessment is triggered if behaviours of concern persist, recur or new ones develop.

However, the behaviour management plan is not always successful in preventing aggressive episodes. Staff report aggressive episodes via incident forms which are gathered and processed by the MACS' Occupational Health and Safety team. If a resident has had three reported aggressive episodes, discussions between the Clinical Care Manager, Behaviour Management RN and GP are conducted and possible solutions considered. The possible solutions, then, are trialled and reviewed for effectiveness.

If aggressive episodes persist, the Aged Care Psychiatric team is consulted and recommendations from them implemented trialled and evaluated. The process continues until there is a satisfactory outcome.


The impact of the Behaviour Management Strategy is
demonstrated in the benchmarking and trend reports.

Indicator: 2.13.1 Aggressive Episodes - Benchmarking Graph Quarter 4

Indicator: 2.13.1 Aggressive Episodes - Trend Graph Quarter 4