What Makes Our Special Care Unit Special ” by ars16282


									    “What Makes Our
Special Care Unit Special ?”

            Deer Lodge Centre
            Dementia Care Unit
     Maureen Chouinard, Manager of Resident Care
        Arlis Decorte, Clinical Resource Nurse
          Nancy Fiebelkorn, Social Worker
        SCU – Tower, SCU-West
   47 beds on two units
   Tower opened in 1988, West opened in 2006
   Higher staff to resident ratio
   Units address behaviours, care needs
   Male or female; veterans or community
            Philosophy of Care
 Equal, individualized, respectful and safe care
 A person’s individuality is unique and does not
  change because of cognitive impairment
 Staff are advocates
 A specialized environment is required for dementia
 Families have the right to be informed
      Philosophy of Care (continued)
   Specialized skills and abilities are essential
   Interdisciplinary team approach
   End of life care
   Upholding Resident’s Bill of Rights
   Effective and efficient use of available resources
         SCU Admission Criteria
   Age
   Primary and secondary diagnoses
   Environment
   Behaviours
   Risks
    How to Access the Special Care
           Unit at DLC
 WRHA Behavioral Panel
 Contact the panel secretary at 940-3600
 Access Office is at 490 Hargrave St.
 Application should include an A/A form, a
  Dependency Assessment Supplement and the
  Behavioral Assessment Supplement.
 A brief summary of the resident/client will be
  submitted along with behavior maps, recent
  progress notes, consults and lab work.
            Behavioural Panel

To facilitate the management of individuals with
  challenging behaviors in the most appropriate care
            Behavioural Panel
              Guiding Principles:
 Behaviors are not being managed in their current
 Existing resources already accessed
 Information meets panel criteria and standards
 Panel meets monthly
 Additional problem-solving may be required to
  ensure placement in proper environment
           Behavioural Panel
           Who Sits on the Panel?
 Medical Director of the Rehab/Geriatrics Program
  Director of the LTC Access Centre or designate
  A representative from a PCH
  A representative from the Geriatric Mental
  Health Team
 A CNS for the WRHA long term care program
 Access Coordinators
 Health care professionals/family who have been
  integral to managing the individual’s care needs
           Preadmission Visits
 Purpose:
   • Confirm the information provided by panel

   • Meet needs of the applicant?

   • Plan for any special needs or equipment

   • Meet the applicant and family

 Completed by the Social Worker and Unit
  Manager once accepted by Behaviour Panel
 Visit usually within one week, at applicant’s
  current residence
   The Interdisciplinary Approach
 The SCU at Deer Lodge Centre utilizes an
  interdisciplinary approach to care.
 Weekly meetings
 Goal is to review each resident on a quarterly
 Post-admission and Annual conferences
 All members of the team are available to family
 Contact information provided
       The Interdisciplinary Team
              Consists of:

   The Resident and Family
   Attending Physician and Consultant Psychiatrist
   Manager of Resident Care
   Clinical Resource Nurse
   The Nursing Team-RNs, RPNs, HCAs
       The Interdisciplinary Team
         Consists of (continued) :
   Social Worker
   Pharmacist
   Physiotherapist
   Occupational Therapist
   Dietician
   Recreation Facilitators
   Spiritual Care
 What Gives Us a
Sense of Well-being?

          -The Bradford Dementia Group
            Well-Being (continued)

What do we need to maintain a sense of
   A sense of control
   A sense of who we are
   A feeling of safety and security
   The ability to communicate with others
   The feeling that we are socially included
          Well-Being (continued)
 Having meaningful things to do
 Being taken seriously- do others respect and
  recognize when we feel frustrated, angry, sad,
  anxious, tired/exhausted, confused, lonely,
           Reactive Behaviours
 Reactive Behaviour- the way in which a person
  responds to a specific set of conditions.
      P.I.E.C.E.S. program
 All residents on the Special Care Unit have a
  behavioural history which has made residing in a
  regular personal care home setting difficult or
   Reactive Behaviours (continued)
Reactive behaviours may include:
 Restlessness          Calling out
 Wandering              Hoarding
 Resistance to Care    Agitation
 Anxiety               Aggression
 Withdrawal
 Inappropriate Sexual Behaviour
   Reactive Behaviours (continued)
Staff are encouraged and trained to monitor and
  document reactive behaviour:
 Antecedents (Triggers)
 Behaviours
 Interventions
 Consequences
Reactive Behaviours (continued)
Reactive Behaviours (continued)
           Key Elements of Care
                Alzheimer’s Australia, 2003

   Assessment
   Individualized Care
   Interdisciplinary Team Approach
   Programming
   Relationships
Key Elements of Care (continued)
    Key Elements of Care (continued)

   Communication Skills
   Physical Environment
   Flexibility in Routines and Practices
   Staff Training and Education
 Communication with persons who are cognitively
  impaired may be difficult and frustrating at times
  for both you and them

 Remember that behaviour is a form of
  communication for residents that have impaired
  expressive ability
          Areas to focus on include:
 Approach in a gentle manner and identify yourself
  by name
 Maintain eye contact
 Provide gentle direction
 Do not make an issue of a mistake, they happen
 Avoid asking facts
    Areas to focus on include (continued):
   Reduction of distractions and background noise
   Reorientation may not work
   Appropriate touch
   Items and illustrations to convey messages
 May be difficult for families/caregivers – We, by
  nature, need something from our visits
   • Love

   • Reassurance

   • Support returned to us

   • Ease of guilt

   • Confirmation of our decisions

   • To feel that a connection remains
             Visiting (continued)
   Goals of Visiting
   Who should Visit
   When to Visit
   Where to Visit
   What to do when you Visit
   Why Visiting may be difficult
   Saying goodbye after your Visit
   When younger family members Visit
       Caregiver Support Group
 Informal group for families/friends that meet once
  a month
 Connections for them, connections for us
 Share questions and information about SCU
 Supportive and safe environment
 Luncheons
                  Case Study
79 year-old gentleman residing on a general medical
  hospital ward.
 dx of Alzheimer’s/Parkinson’s disease.
 hx of resistance and aggression during care,
  occasionally towards co-residents.
 Poor response to psychotropics - oversedation-
  minimal effect on behaviour.
                  Case Study
  Care Plan in General Hospital Setting
 6 staff to provide care
 Resident to be restrained on bed utilizing 4 staff,
  2 staff to prepare and provide care.
 Broda with lap table for meals and rest periods.
 Current Rx
   • Carbamazepine 200mg bid

   • Trazodone 75 mg od 18:00
                 Case Study
         Care Plan on SCU - Goals
 Gain the resident’s trust.
 Create a “resident-friendly” care plan.
 Involve resident and family in care planning-
  create an environment where resident and family
  have decision-making authority.
 Ensure Consistency/reliability.
               Case Study
    Care Plan on SCU - Interventions
 ADL Care
 Broda chair and table for meals.
 “Bath-in-a-bag” products - no tub baths, no
 Incontinent product-pullup/brief/overnight
 Monitoring behaviour on unit
 Plan all care - Scheduled………..CONSISTENT
                 Case Study
       Care Plan on SCU (continued)
 Initially provide 4 staff for care and safety
 “Normalized care”, bathroom routine
 When resident requires care, approach and “be
  with” resident
 Reapproach after a “break period”, invite him to
  attend his room with you, or simply walk to room
  with him.
 If care required more urgently, need to be more
  “matter of fact”
                 Case Study
       Care Plan on SCU (continued)
 Adjustment to medication following admission
 Trazodone Rx on revised care plan:
          07:00 - 25 mg.
          12:00 - 50 mg.
          17:00 - 50 mg.
                  Case Study
       Care Plan on SCU - Outcomes
 2-3 staff to provide care, dependant on mood -
  (do not provide care alone)
 Aggression with co-residents
 Broda chair/table for meals
 ADL/Bathing
 Ongoing staff education
 The challenge of CONSISTENCY
             End of Life Care
 Advance Care Plan/Health Care Directive
 Care planning around a progressive illness
 What is Comfort Care and its focus?
     • Pain

     • Difficulty Swallowing

     • Lack of Appetite

     • Labored Breathing

     • Skin Breakdown

     • Loving Presence
   When the Resident No Longer
          Requires SCU

 Resident no longer requires the specialized
  programs of our unit.
 Social Worker prepares the family
 Move to another unit in DLC or another facility
            Barriers to Discharge
   Long Wait Lists
   History of reactive behavior
   Families reluctance to move
   Concerns of receiving facility
        • Small unit vs large unit

        • Treatment unit vs long-term care unit
          What Have We Learned?
 The value of the unit staff
 Admissions – need to try new things
 Environmental challenges
   • Closed-in vs. open spaces, Wall protection,
 Low stimulus is a great idea but……
 Require a balance between environment and
  pharmacological treatment

To top