Reduction of Disruptive, Aggressive Behaviour On the Older Persons Ward

Who is involved? Chris Cudlip – Patient Safety Lead Karen Williams – Ward Manager Sam Snell – Occupational Therapist Jonathan Speed – Deputy Ward Manager Louise Crane – Patient Safety Administrator

Situation Project Initiated

Background Programme started September 2015 High level of Disruptive and Aggressive behaviour on the wards Staff unable to quickly identify a person’s needs Patients remained on enhanced observations longer than clinically required Recording processes needed a meaningful person centred approach to reflect patients needs for a more rounded assessment on the ward

Benefits to the patient and staff Patient safety Patients experience Staff safety Staff experience Better ward environment Increased staff retention Reducing staff sickness levels

Assessment Secondary Drivers: Aim/Primary Outcome: Primary Drivers: Person centred care / Cornwall Supporting Behaviour Pathway Physical health Medication Communication Patients Reduction in Disruptive Abusive Behaviour (DAB) on Garner Ward by 40% in 12 months. Communal areas Noise / temperature Doors Number of occupied beds Environment Staff Communication Weekly Patient Safety Huddle Training / involvement Support / supervision Open and just culture Culture Engaged and committed leadership

Measuring the effects of changes Safeguard Huddles initiated Level 2&3 Obs Chart initiated Project Initiated

Measuring the effect of change 34% reduction in DABs incidents in the first 12 months.

Rolling Year Data

Number of patients involved in the DAB incidents

Initiated on admission and discharge. On file with care plans. Used from level 3 obs.

Care Plan

This is a chart that had been trialled and altered following feedback given

This is the reviewed and altered Level 2 and 3 Observations Chart now adopted on the ward.

Relative Feedback received “I have noticed that non regular staff appear more aware of John’s* needs. One lady was able to engage in appropriate ‘banter’, but knew exactly what to do when he started to shows signs of agitation. I’m sure John* would have become aggressive if she didn’t know to stop engaging and give him space”. AW * (patient family member) *names have been changed.

Completed PDSAs Library Care Plan will incorporate traffic light care Behavioural traffic light passports have been adopted into main practice with good results and feedback. Some families are aware of the traffic light passport and are encouraged to contribute. Planned weekly huddles held with Deputy Ward Manager, HCAs and Psychologist.

Update Started using Level 2&3 Obs Chart beginning Dec 2016. Which incorporated a sleep chart therefore reducing the number of forms needed to complete per patient. Safeguard Huddles initiated every Tuesday morning (protected time) since November 2016. Discuss incidents raised over past 7 days Review and update care plans and risk assessments to reflect identified reports raised within the past 7 days Review observations charts for patients on level 2 and 3 with the view of checking and subsequently decreasing the level of observation for patients not presenting at triggering or escalation phase behaviour Linking with incidents reflecting the observation charts and discuss amongst wider team to encourage open and just culture

Next Steps Further development of traffic light passport for nutrition, moving and handling and personal care. Good feedback received from HCAs. Electronic application funding is being sought by Medical Director so that the data can be analysed from ten minute observations. Embed Safety Huddles into weekly practice

Recommendations Keep talking to staff about what we are trying to achieve Continue to foster family involvement and awareness of the Patient’s Traffic Light Passports. Continue to keep all members of the ward team actively involved in all processes and decisions. Allocate protected time to keep moving forward Report back to safety champions

Barriers Positive Outcomes Time alongside frontline role Staffing levels within the ward Positive Outcomes Increased awareness and compliance of reviewing and utilising the traffic light system Eradicated needless duplication of paperwork Meaningful Person Centre Approach

Key improvement message “Everyone has a part to play in the planning and implementation of the project.”