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Shelley R McDonald

Development of an Educational Program to Improve the Skills of CNAs to Recognize, Report, and Respond to BPSD. Shelley R McDonald. Background. 3.2 million residents resided in a nursing home in 2008 – CMS NH data compendium 68% had noted cognitive impairment 10.4% was severe to very severe

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Shelley R McDonald

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  1. Development of an Educational Program to Improve the Skills of CNAs to Recognize, Report, and Respond to BPSD Shelley R McDonald

  2. Background • 3.2 million residents resided in a nursing home in 2008 – CMS NH data compendium • 68% had noted cognitive impairment • 10.4% was severe to very severe • 80-90 % of patients with dementia develop at least one distressing behavioral symptom over the course of illness

  3. Objectives • To improve the abilities of the front-line staff to: • Recognizeeach problem behavior • Reportproblem behaviors • Respond by using nonpharmacologic interventions (NPI)

  4. Case-based Educational Program • Secured dementia unit in a community- based NH • Monthly interdisciplinary case conference (behavior rounds) • Front-line staff chooses a resident to discuss • Systematic characterization of: • the behavior • possible antecedents

  5. Implementation • Feasibility • Attendance • Coverage • Efficiency • Communication • Education • Resource folders • Pocket Card • Behavior Team

  6. Pocket Card: Recognition

  7. Pocket Card: Responding & Reporting

  8. Residents with Behaviors Implementation Feasibility

  9. Documented Behaviors per Month *

  10. Perspectives • “it made you relate to how that person was acting and how you would want to be treated” • “now able to know what behavior they are having” • “can get more involved by taking them to see something they like” • “CNAs now run the floor” • “it is a great team” • “used to be the most difficult unit, now it is one of the best” • CNAs “ feel important”

  11. Conclusions • Engaging front-line staff is crucial for person-centered care • Behavior rounds held on a monthly basis has improved the ability of the front-line staff to recognize, report, and respond to difficult behaviors in persons with dementia • Ongoing training and reinforcement is needed • Have to have an in-facility champion

  12. Acknowledgements • The Pavilion at Croasdaile Village • Heidi White, MD, MHS, Med, CMD • Mitchell Heflin, MD • Sandro Pinheiro, PhD • Mugdha Thakur, MD • Billie Jean Best, RN • Iris Pleasants, RN • Rebecca Marion, LNA

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