What Makes Our Special Care Unit Special ” by ars16282

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									    “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
    applications
            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
  care
 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
                     Purpose:


To facilitate the management of individuals with
  challenging behaviors in the most appropriate care
  setting.
            Behavioural Panel
              Guiding Principles:
 Behaviors are not being managed in their current
  environments
 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
  basis.
 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
 well-being?
   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,
  frightened?
           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
  impossible.
   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
 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
              Communication
          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
                Communication
    Areas to focus on include (continued):
   Reduction of distractions and background noise
   Reorientation may not work
   Appropriate touch
   Items and illustrations to convey messages
                    Visiting
 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
  showers
 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
                  Conclusion
          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,
     Decoration
 Low stimulus is a great idea but……
 Require a balance between environment and
  pharmacological treatment

								
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