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Improving the patient experience through behavioural support

Wednesday March 29, 2023

Patients experiencing delirium or dementia while in hospital can often require specialized care to support feelings of confusion, overwhelming emotions, and responsive behaviours. For families, this change in behaviour can be hard to understand and manage. For staff, it’s accompanied by additional challenges in providing care, often resulting in the need for an individualized care plan.

To support these patients and families, Southlake launched the Behavioural Support Team in 2022. The Behavioural Support Team (BST) works with staff to build capacity and provide care for older adults with complex needs and responsive behaviours/personal expressions associated with dementia. The team aims to reduce or prevent behaviours/expressions and their associated risk. By collaborating with unit staff to carry out the orders, suggestions, and care plans that the BST puts in place to aid in behaviour management, the implementation of the BST has helped improve patient satisfaction, support staff, and provide families with a sense of peace.

Southlake’s BST consists of a Nurse Practitioner (NP), Registered Nurse (RN), Registered Practical Nurse (RPN), Recreation Therapy Assistant (RTA), and a security ambassador. All members of Southlake’s BST have education and experience in geriatrics and behaviour support.

“By working directly with the patient, they can complete comprehensive assessments and medication reviews to create tailored interventions,” said Alyson McQueen, Director, Medicine Program, Southlake. “Through regular collaboration with members of the patients’ care teams, and by spending time with the patients to learn as much as they can, the BST develops and implements engagement tools and activities to support patient’s while they are admitted to hospital. The team is also a constant and familiar presence on the units and is able to identify behavioural situations before they escalate.”

The team has supported many patients and have seen improved quality of life for those they treat, as well as improved communication and understanding from the patients’ families. Take 86-year-old patient Mary for example.

“Mary was diagnosed with mild to moderate mixed dementia and there were concerns of a decline in cognitive function for Mary, which lead her to Southlake’s Transitional Care Unit (TCU) while waiting to move to a long-term care home,” said Ciera Cook, Nurse Practitioner. “Staff noticed Mary was not sleeping, calling out all night, disruptive to other patients, would resist, when care was provided and was refusing her medication. These responsive behaviours prompted a referral to the BST.”

During Ciera’s assessment of Mary, she was able to determine Mary was suffering from an infection, dehydration and was able to treat her accordingly. She also reviewed her current list of medications and made some adjustments, all to help manage her responsive behaviours related to her dementia. In addition, she referred her to a community resource called LOFT, who’s role is to observe Mary in hospital and complete a holistic evidence based comprehensive assessment of her behaviour and provide a care plan. They also supported Mary’s transition to a long-term care setting.

Bethany Ledlie, RN and Meredith Weber, RPN were able to identify that staff were struggling most with verbal behaviours, physical behaviours, and resistance to care.

“When we spent time with Mary, we were able to learn that she enjoys socialization, one-on-one engagement and self-propelling in her wheelchair. She does not like isolation, seclusion, is uncomfortable around men and can become possessive over people and objects that she has formed emotional bonds with,” said Bethany Ledlie, Registered Nurse.

“We used our therapeutic relationship, knowledge of her triggers and known successful interventions to aid staff on Transitional Care Unit (TCU) in the management of Mary’s behaviour” said Meredith Weber, Registered Practical Nurse.

Renée, the Recreation Therapy Assistant engaged Mary in group activities and individualized interests such as baby dolls, robotic animals, and colouring during many recreational interventions that staff were able to carry out at any time. Amber, the BST Security Ambassador, was a constant and familiar presence on the unit and helped identify behavioural situations before they escalated. With Mary, Amber was able to spend extensive amounts of time with her and in turn was able to create trust and understand her likes and dislikes as well as their triggers and successful interventions to help de-escalate them when necessary. These interventions greatly improved Mary’s quality of life, provided her with meaning and purpose, and ultimately improved her behaviour helping to avoid unsafe interactions entirely.

The BST worked closely with TCU staff and allied health staff to manage Mary’s responsive behaviours related to dementia. Mary was able to be successfully discharged to an external Behavioural Support Unit in early December 2022.

Through the collaboration, expertise, and trust of the staff on each unit that the BST supports, Southlake is caring for patients with responsive behaviours in a compassionate and kind manner that meets the needs of the patients and their families.

*Patient names have changed to protect their identities.