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Improving Mental Healthcare in Nursing Homes

Improving Mental Healthcare in Nursing Homes. Brenda K. Keller, MD,CMD, Cameo Rogers, CTRS, CDP, Jennifer Medlin Hannah Fillman , Thomas M. Magnuson, MD. Goal of Project. To teach non-pharmacological interventions for management of behavioral problems in dementia to nursing home staff.

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Improving Mental Healthcare in Nursing Homes

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  1. Improving Mental Healthcare in Nursing Homes Brenda K. Keller, MD,CMD, Cameo Rogers, CTRS, CDP, Jennifer Medlin Hannah Fillman, Thomas M. Magnuson, MD

  2. Goal of Project • To teach non-pharmacological interventions for management of behavioral problems in dementia to nursing home staff. • To test the effectiveness of these educational efforts. • To reduce the overall prn and scheduled psychotropic use by introducing non-pharmacological methods into daily resident care.

  3. Part I: Education

  4. Methods • All staff at 120 bed facility received two- hour long sessions focused on non-pharmacological behavioral management and use of activities to prevent behaviors. • Tip sheets group- learned about aggression, wandering, and disruptive vocalizations • Activities group- learned how to use activities as a proactive measure for behavior management and lead and adapt small group activities for multiple ability levels

  5. testing testing

  6. Mental Health Topics General Principles Aggression Wandering Disruptive vocalizations Depression treatments Anxiety Relaxation techniques Insomnia treatments

  7. Activity Guides / DVD

  8. Assessment Tools Knowledge Attitudes

  9. Participants N=40*

  10. Results Dementia Knowledge Questionnaire Results for Tip Sheets Group *significant data

  11. Difference Between Pre and Post Test Scores for Tip Sheets Group *X2 = 8.77 p < 0.05 CNA participants improved their knowledge of the causes of dementia

  12. Part II: Resident Outcomes

  13. Methods • Measured the percent of residents on routine antidepressants, antipsychotics, anxiolytics, and hypnotics each month. • Measured the number of residents using prn doses of psychotropic drugs more than twice monthly. • Measured the number of incidents of behavior problems affecting other residents monthly. (MDS) • Measured the percent of residents feeling more depressed and the percent with depression without treatment monthly. (MDS) • Used data from November 2009 to April 2010 to calculate the 6 month historical average for comparison.

  14. Historical Ave: 48.5 Months New ave =49.3 Stdev= 3.2

  15. Resident Antipsychotic Drug Use Percent New Average 8.125 STD 1.73

  16. Resident Antianxiety Drug Use Percent New Average= 8.25 Stdev=2.12

  17. Resident Hypnotics Drug Use Percent New average= 4.85 Stdev=0.83

  18. +Intervention Began: June 18, 2010 * P < 0.05

  19. Limitations • Low participation 40/152 in survey may minimize the true effect of educational intervention on patient outcomes. • Change in MDS mid intervention allows for only 3 months of f/u of behaviors

  20. Conclusions • The tip sheets lecture overall helped increase the CNAs’ knowledge of dementia etiology. • The lectures did not significantly affect the knowledge and confidence of the participants, however an overall increase in both areas was observed. • The percent of residents using routine antipsychotics, anxiolytics, and hypnotics showed a trend toward decrease following the intervention but did not reach statistical significance. • The percent of residents using prn psychotropic medications used decreased significantly during the intervention • The percentage of resident behaviors affecting others significantly decreased during the of intervention.

  21. Unanticipated outcomes • Lectures now part of new staff orientation at test site • Tip sheets and Activities DVD to be incorporated into education policies and procedure for Vetter Health Services, owner/operators of 32 long-term care facilities in Nebraska, Kansas, Iowa, Missouri and Wyoming • Tip sheets available at: • http://www.unmc.edu/intmed/geriatrics/nursing_home_personnel.htm

  22. Thanks • AMDA Foundation/Pfizer for support of this project • Staff and Administration at Brookestone Village • Cameo Rogers, CTRS, CDP • Jennifer Medlin, M1 supported by AFAR MSTAR program • Hannah Fillman, supported by the UNMC Student Undergraduate Research Program • Thomas M. Magnuson, MD

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