BRADLEY CENTER ACTION AND IMPROVEMENT TEAM
Bradley Center Bradley Center is a home to 90 residents with complex chronic conditions.
• Bradley Center is a home to 90 residents with Complex chronic conditions. It is located in downtown Chilliwack attached to Chilliwack General Hospital. Our residents receive a Person- Centered Approach to Care from over 100 multi-disciplinary health and non-health staffs 24/7. It is owned and operated by Fraser Health Authority under the BC Provincial government. • Unique features and Our challenges: Our building is built in the early 1970 with hospital-like atmosphere; we offer 3 types of accommodations: a 4-bed unit, 2-bed unit and a single-bed unit with an en suite bathroom. The institutionalized environmental plan often contributes to aggressive outburst and resident confusion: An example is our overhead system that is linked to the hospital. The loud code calls are heard in their rooms and these trigger some behavioural responses from our residents. We try to make each resident’s unit more “homey” by allowing them to bring in some of their memorabilia that will remind them of their home. And we also try to remove all the clutter specially in the hallways for more space. • Our Edge: 18 months ago, we implemented a targeted enhanced medication process and this included the review and weaning of anti-psychotic medications; Removed 13 Anti-psychotic drugs and 2 re-instated in 3 months. This included the review and weaning of anti-psychotic medications. Our initial intervention was very successful with 195 medications discontinued over 90 residents. Of those medications, 13 of those were antipsychotic drugs. At the three month review two of these had been restarted. • At present, we have 17 resident on regular dosing without a psych diagnosis. Two residents have a diagnosis. Some of the orders were discontinued initially and over time the behaviours eg. sexually inappropriate behaviour became problematic again and meds were restarted.
Be CLeAR! Bradley Center ActionTeam • Teresa Armstrong , RN, Manager, Administrator ( in currently on leave) • Anne Fleming– RN, RCC, degree in gerontology; initiated the initial Polypharmacy management initiative, Project team leader, Data collector/analyzer • Glennis Edens, RN, GN(C); team leader, working in gerontology since 1982; Data Collector/Liaison. She says, “ I’m hoping to understand why it is better to be off anti-psychotic medication and hoping to be a liaison to frontline staff and be the informal educational support by offering teachable moments” John Isaak – LPN, will assist with data collection and change agent • • Ruth Castillo-Sebastian RN, CNE, worked in 3 countries –Philippines, UK and Canada with gerontology as a focus; Quality improvement/facilitator, “Hoping to see residents have a quality of life lived to the fullest , free from all types of restraints, respected and dignified.” • Michelle Murray, RN, GNC (C) Quality Improvement agent. She says, “ I see this as an opportunity for learning, and I'm also interested in improving the quality of care for our residents who have dementia.” • Allen Siemens, HCA – have recently joined the team and have become an advocate of person-centered approach as a result of this project. • Dr. Erin Lynch – Medical Director
WHAT WE WISH FOR OUR RESIDENTS… We would like to see the staff given the education and skills to interact effectively with our residents with challenging behavior thereby reducing and eliminating the need for anti-psychotic medication use.
• Our Process map – question: What is our process in the management of residents with BPSD? • Our Gap: Staff are not clear on what Non- pharmacological interventions to give our residents with BPSD. We feel that they need more education and support; Need a culture change. • Where we at now in our process? Our team just finished collecting all the initial data from our residents and in the process of collating our statistics. Meantime, the quality improvement team are collecting all policies, resources and CPG related to BPSD.
We made a difference!!! • Volunteers were involved in adding more activities in the evening after dinner for those residents who are “sundowning” • Nurses are now more aware to trial non- pharmacological interventions or analgesics first or anti-depressants second before resorting to anti- psychotics • Bradley is now currently involved with CFHI Polypharmacy reduction project to continue this work.
We tried, but…… • We tried to use Lemon-Balm aromatherapy with the support of our Medical Director but not 100% successful, sort of hit and miss. Nurses recorded that in the morning the therapy is about 90% successful but not so in the evening. Further improvement in the documentation and consistency of therapy should be made.
This is why it was all worth it…… • The family of the resident whom we tried the aromatherapy was so satisfied with the attention and support our team are giving to help alleviate the challenging behaviour of our resident with reduced use of anti-psychotics. • This individual is now more alert, has less behaviour issues and have a better quality of life.
This is what happened Start Sept 2013 - 17.8%, ending with Nov 2014 – 23.3%. Our % rate of use has always been fairly low (about 12% at the start of the project) due to starting this type of management in 2012. What we did find is that we have a steady rate of admissions from acute already on Antipsychotic medications. Because of this, it is challenging to drop our rate. We make a concerted effort to assess and wean these medications as the residents settle into their new home at Bradley Centre. We have had a slight increase in our % up to 17% due to this (17 admis sions in the last quarter). Ongoing are PIECES, BPSD algorithm and the CFHI Dementia Education Series education for staff .
My wish…… I have enjoyed the education sessions around this project and particularly liked having a formal collection tool to work with as previously I had collected data on my own on a hardcopy. Most illuminating for me was the high percentage of admissions from the hospitals on these medications (w/o a psych diagnosis) most probably due to the high rate of delirium experienced by geriatrics in acute medicine and the poor sleep quality experienced in hospitals. My wish would be for a more geriatric friendly hospital environment therefore decreasing the use age of these drugs in acute. - Anne Fleming ,RCC Project Teal leader, data collector
Bradley Center Contacts: Location 45600 Menholm Road Chilliwack, BC V2P 1P7 (604) 795 4103 Anne Fleming, RCC anne.fleming@fraserhealth.ca Ruth Castillo-Sebastian,CNE ruth.castillosebstian@fraserhealth.ca
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