CLeAR The Residence at Clayton Heights is located in a new family - PowerPoint PPT Presentation

CLeAR

The Residence at Clayton Heights is located in a new family orientated community in Cloverdale, BC. We are a 24 hour Campus of Care for specialized populations which are Complex Care, Acquired Brain Injury Program for young adults and Older Adult Mental Health & Substance Use Tertiary Care. Our Multi-Disciplinary Team practices the Social Model of Care. Our services include:  Pet Therapy  Music Therapy  Professional Foot Care  Hair Salon  Dentistry  Hearing Clinic  Occupational Therapy  Chaplin Services  Innovative Holistic Therapeutic Recreation Programs 7 days/week  Chefs Club  Ethnically Diverse Cuisines prepared by a Red Seal Chef  Family and Resident Councils 2

In our Complex Care program, our goal was to reduce our anti-psychotic drug use by 50% by December 2014. We planned on doing this by providing our staff with ongoing education and support. By doing so, we empowered them to fulfill the common goal of an overall increased quality of life. We had joined the CLeAR initiative as we were very excited to learn different approaches to help deal with certain behaviours/symptoms that normally trigger the assessment/administration of a psychotropic medication. We understand that all behaviour has meaning; therefore we wanted to learn how to further reduce triggers in the environment that often result in these behaviours. 3

• Providing small group information sessions for staff in specific neighborhoods allowed the team to address any concerns regarding managing behaviours. • Information sessions allowed discussion to occur building awareness for all health care staff about the inappropriate antipsychotic use which has carried forward as the CLeAR initiative comes to an end. • The Behavioural and Psychological Symptoms of Dementia (BPSD) algorithm provided a useful framework for understanding behaviour management • Our facility will be implementing P.I.E.C.E.S education which aligns with assessing all aspects of the person in care and how this may be relating to their resulting behaviour. 26-Jan-15 Canadian ICU Collaborative 4

Medication Reconciliation: We attempted to have our Licensed Practical Nurses (LPN) review antipsychotic medications prescribed from previous placements upon move in, however there isn’t always background information to inform why the medication was initially prescribed and the LPNs were not always informing the CLeAR team. The physicians would have to review the medication and the LPNs would need to assess and evaluate if there is a need for the antipsychotic medication. We learned that this process can take longer as the staff are still getting to know the person in care and understand what behaviours or traits may be related to their medication. We will continue to do medication reconciliation and remind our RNs, RPNs and LPNs to be aware if antipsychotics are prescribed and to inform the CLeAR team. We understand that the evaluation time will take longer , but we are aware that we need to be responsive to these medications when someone moves in and begin our assessments as soon as possible. Canadian ICU Collaborative 26-Jan-15 5

CLeAR aligns with our vision and values as we follow the Social Model of Care at the Residence at Clayton Heights. Our mission is to use a holistic approach to care for our residents. The CLeAR initiative was an easy step towards ensuring our vision and values are met. One of our success stories we are celebrating was submitted in the CLeAR newsletter. The positive experience involves a female resident who moved to our facility with an antipsychotic prescription. We involved her in our CLeAR initiative and started assessing her for two weeks prior to making any changes. She was observed to always be drowsy, falling asleep at the dining table, not participating in any activities and her lack of participation caused her husband to hold himself back as well. After the two week period we obtained consent from the resident, husband and family and spoke to the physician to make them aware of our findings. The physician and the family agreed with our plan to taper down the antipsychotic and then discontinue. Once the antipsychotic was discontinued, care staff observed a remarkable change in her behaviour and level of activity. Now the resident could be seen participating in exercises, socializing with other residents including her husband, alert and does not ask to go to bed after meals. She enjoys getting her nails painted and her hair done. Now since she is more awake and alert, she has been able to get new eyeglasses and have her hearing aids fixed. Following the discontinuation of the antipsychotic medication, her desire to socialize with staff and family became more frequent, resulting in a greater quality of life. Her husband has also benefited as his interactions with her are more joyful and meaningful. 6

After attending the kick-off event in Vancouver in October 2013, we organized an in-house • kick-off event for the staff to promote the initiative and to bring awareness. During the event we provided anonymous feedback forms to staff to provide their concerns and fears about reducing the use of antipsychotics. In education sessions for CLeAR, we stressed that only inappropriately used antipsychotics would be targeted. We received feedback then observed how staff reacted. Once staff were provided with tools • and information on what type of interventions or behaviour management techniques can be used, they were more comfortable with the concept of CLeAR and are able to use this in their daily practice. For instance, if there is a person in care who is fixated on a specific topic, rather than administering a PRN for “agitation” speaking to the person and going along with their stream of thought can be more settling for them than trying to re-orientate them to reality. Staff are more aware now in observing behaviours and attempting to understand their cause and • using different interventions first rather than using medical intervention as an initial step. 7

We have 29 persons in care (PIC) in each of our 3 Complex Care neighborhoods. The CLeAR team would get together with the Licensed Practical Nurse in each neighborhood and assess which PIC would be suitable for the CLeAR initiative. After determining whose medication should be evaluated, we began behaviour and sleep pattern records prior to and after the antipsychotic was tapered/discontinued. We did not include PICs that had a psychiatric diagnosis. We introduced the BPSD algorithm and will be educating staff further in 2015 with P.I.E.C.E.S education. The following graphs look at the total number of PICs on regular , PRN, or both on antipsychotics against the total number of Complex Care PICs. 8

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We have definitely changed the way we think about antipsychotics and questioning whether or not • they are appropriately prescribed. Especially if the medication is being prescribed for sleep. Ah-ha moments: We not only began assessing for inappropriate use of antipsychotic medications but • also began seeing gaps where a person in care may benefit from an antidepressant or anti-anxiety medication. Our facility benefited from being involved in CLeAR as it allowed us to thoroughly analyze the • medications our persons in care are prescribed. CLeAR aligns with our facility’s vision & values: Social Model of Care • Continue providing a person-centered approach • Improve quality of care • Enhancing the lives of the people we serve • Because we practice a holistic social model of care, we are already practicing a person centered • approach and other non-pharmacological strategies including: Individualized Care Plans, Caring Journey, My Day, Violence Prevention, and Holistic Recreation Therapy Services. CLeAR has added to providing individualized care through medication review and by using different interventions rather than PRN antipsychotic medication. Our plans post-CLeAR are to continue educating staff about behaviour identification and management • through P.I.E.C.E.S and Mandt System Training. We will continue to collect data each month and analyze the inappropriate use of antipsychotics and • continue the initiative put forth. 13

Karin Lauff- Clinical Services Administrator (604) 576-2273 ext. 201 or 102 or email: karin.lauff@pinnaclecaregroup.com Lynette Nand– Program Manager (604 ) 576-2273 ext. 212 or 117 or email: lynette.nand@pinnaclecaregroup.com 14