Development of an Educational Program to Improve the Skills of CNAs to Recognize, Report, and Respond to BPSD Shelley R McDonald

Background 3.2 million residents resided in a nursing home in 2008 – CMS NH data compendium 68% had noted cognitive impairment – 10.4% was severe to very severe % of patients with dementia develop at least one distressing behavioral symptom over the course of illness

Objectives To improve the abilities of the front-line staff to: – Recognize each problem behavior – Report problem behaviors – Respond by using nonpharmacologic interventions (NPI)

Case-based Educational Program Secured dementia unit in a community- based NH Monthly interdisciplinary case conference (behavior rounds) Front-line staff chooses a resident to discuss Systematic characterization of: – the behavior – possible antecedents

Implementation Feasibility – Attendance – Coverage – Efficiency – Communication Education – Resource folders – Pocket Card – Behavior Team

Pocket Card: Recognition

Pocket Card: Responding & Reporting

Residents with Behaviors Feasibility Implementation

Documented Behaviors per Month *

Perspectives “it made you relate to how that person was acting and how you would want to be treated” “now able to know what behavior they are having” “can get more involved by taking them to see something they like” “CNAs now run the floor” “it is a great team” “used to be the most difficult unit, now it is one of the best” CNAs “ feel important”

Conclusions Engaging front-line staff is crucial for person- centered care Behavior rounds held on a monthly basis has improved the ability of the front-line staff to recognize, report, and respond to difficult behaviors in persons with dementia Ongoing training and reinforcement is needed Have to have an in-facility champion

Acknowledgements The Pavilion at Croasdaile Village Heidi White, MD, MHS, Med, CMD Mitchell Heflin, MD Sandro Pinheiro, PhD Mugdha Thakur, MD Billie Jean Best, RN Iris Pleasants, RN Rebecca Marion, LNA