Sea View Hospital Rehabilitation Center & Home Nancy Endozo, R.N., B.S.N.

1. Reduction of Antipsychotic Medication in the Long Term Care Dementia Population Utilizing Novel Non-Pharmacological Approaches Sea View Hospital Rehabilitation Center & Home Nancy Endozo, R.N., B.S.N. Marian McNamara, R.N. M.S.N.

2. Speaker Disclosures Nancy Endozo, R.N. and Marian McNamara, R.N. disclosed that they have no relevant financial relationship(s).

3. Learning Objectives By the end of the session, participants will be able to: • Implement a successful antipsychotic reduction program. • Identify non pharmacological approaches to address behaviors in the Dementia resident. • Implement an Employee Wellness Program.

4. Facility Demographics • Sea View is one of 16 facilities in the New York City Health and Hospitals Corporation. • 304 Bed Facility located in Staten Island, NY. • 60% of the entire population have Dementia diagnosis. • 21 Bed Traumatic State Certified Brain Injury Unit. • 76 Bed Dementia/Alzheimer Unit.

5. Problem Statement • Literature suggests Antipsychotic medications are often given to residents with Dementia who exhibit behavioral or psychological symptoms. • Evidence based practice reveals when antipsychotic medications are used for the purpose of limiting or controlling behavior there is little chance of effectiveness.

6. Reason for Selection • Sea View Statistics Antipsychotic Drug Use. • 2012 CMS launched National Partnership to improve Dementia care and reduce antipsychotic drug use in nursing homes. • Nursing Home Quality Pool Initiative.

8. Goal • Discontinuation or reduction of antipsychotic medications, thus optimizing quality of life while maintaining safety and functionality of our residents.

9. Results of Initiative

10. Implementation of Quality Initiative • Interdisciplinary resident centered approach. • Development of Behavioral Improvement Meeting/expression of unmet needs meeting. • Continuation of medication management weekly unit rounding. • Development of Dementia Care Policy incorporating CMS guidelines including psychoactive medication tracking form. • Enhancement of Dementia education curriculum utilizing evidence based practices. • Incorporation of numerous NOVEL non-pharmacological approaches into resident specific plans of care. • Commencement of Employee Wellness Program into practice. • Facility wide in-service with Dementia competency assessment post education.

12. Non Pharmacological Approaches

13. Bio Frame

14. Walking Program/Sunshine Group

16. Mood, Music, Memory Program

17. Sensory Room

18. Sensory Room

19. Sea View Casino

20. Sea View Cinema

21. Adopt a Resident ADOPT A RESIDENT PROGRAM GUIDELINES Programs Focus: (Non - Interactive Residents) This is a PI Project being conducted by Activities the focus of the program is for staff to spend some quality time with a resident who is non-interactive, lonely, just needs someone to visit with. All interested staff will be enrolled into the program and resident assignments will be made by the Kelly Curry, Director of Activities. The visit time should be about 15-20 minutes. This time will be approved by their Supervisor and will take place during the course of their work schedule or if the staff member prefers on their own time (after work). Visit Form Validation: (Program follow-up) The program candidate will be expected to schedule a visit one day a week and will also be expected to document their visit and comment on their progress. This will be done on a validation form that will be provided and collected monthly. This form is a very important component of the PI Program because it monitors resident involvement and stimulation while the visit takes place. It is extremely important that this form be submitted back to Kelly Curry, Director of Activities so that the data collected can be recorded and documentation be reported to the PI Committee Quarterly. Resident Outcome: Residents involved in the program will also complete a monthly evaluation on their progress, input and needs. Supervisors Decision: If for some reason the supervisor feels that this is not working out and the program has a negative effect on productivity than they have the right to remove the staff member from the program. You’re time spent with your “adopted” resident, should be something they’re interested in doing. Find out their interests, preferences and/or needs. If the resident you’ve adopted has an unusual request, let me know, so perhaps we can work it out. Many residents will just enjoy having a conversation with you, sharing stories or getting off the unit for a while. Perhaps you may accompany them to the greenhouse, spend time with them listening to the piano music downstairs, outdoors when it’s warmer outside or share a meal with them. Other recreational activities may include: Working on a special Art project with them, setting up small “jobs” they can help you with, and will likely give them a sense of purpose. If you need materials/ independent projects, please inquire within the Activities department. Remember we would like to reach those residents that normally do NOT attend Activity programs. BE THEIR SUPPORTER! This program has great potential and can only add to the ongoing high level of care and continuous efforts to support resident satisfaction.

22. Employee Wellness Program

23. Employee Wellness Program

24. Video • Video produced by IPRO as an educational component. • Team in action. • Video Website

25. Sea View’s Inspirational Words Thank you for your kind attention. Life is a journey not a destination! We are more than happy to share our program to all who are interested to provide continuous quality to all our residents. Speakers can be reached at: nancy.endozo@seaviewsi.nychhc.org marian.mcnamara@seaviewsi.nychhc.org