2. ABSTRACT
The 6A acute care unit has been seeing a higher number of patients that are afflicted with dementia. Often times, these patients display challenging dementia-related behaviors. It is commonplace for these patients to be medicated with a psychotropic medication in order to halt the challenging behavior. The global aim of this project is to improve dementia care on the 6A acute care unit. The specific aim, educating staff members about the benefits of nonpharmacological approaches in the management of challenging dementia-related behaviors and to encourage their use, is relative as the education is necessary before improvement can be expected to begin.

3. STATEMENT OF THE PROBLEM
According to the World Health Organization (2015), currently, approximately 47.5 million people are afflicted with dementia, and it is estimated that this number will more than triple by This project was developed from concerns, which arose during practicum experiences, in regards to how challenging dementia-related behaviors were addressed. It was noted that, at any given time, there are between five and ten patients on the unit with dementia. More often than not, there is at least one patient which displayed significant and disruptive challenging dementia-related behaviors. It was also noted that nursing staff routinely administered antipsychotic medications in an effort to manage those behaviors. After these observations, a chart review was conducted and a performance gap was noted in the standard of care. During the chart review, it was determined that as many as 90% of patients of patients exhibiting challenging dementia-related behaviors were medicated with antipsychotic medications

4. PROCESS MAP Staff attends to patient Staff reviews orders
Patient exhibits challenging behavior
Staff performs documentation
Staff administers medication
Staff retrieves medication
Staff monitors patient
Staff performs PRN effectiveness

5. Why nonpharmacological approaches are not being used
FISHBONE DIAGRAM
Physical environment
Patients
Lack of suitable activities Isolated
for dementia patients
Distance of patient rooms Not always able to verbalize their needs
from nurses’ station
Why nonpharmacological approaches are not being used
No defined process Ineffective rounding
EBP not followed Knowledge deficit
Float staff
Process
Staff

6. SWOT SWOT ANALYSIS STRENGTHS WEAKNESSES OPPORTUNITIES THREATS
Improving patient outcomes
Preventing unnecessary use of antipsychotics
Cost effective
Educational growth
WEAKNESSES
Staff resistance to change
Staff may not realize benefit
Staff time required for education
OPPORTUNITIES
Improved patient-staff relationships
Improved staff satisfaction
Potential for expansion to other units
THREATS
Fluctuating census
Noncompliance
SWOT
Preventing unnecessary use of antipsychotics
Improving patient outcomes
STRENGTHS
Educational growth
Cost effective
Staff time required for education
Staff may not realize benefit
Staff resistance to change
WEAKNESSES
Potential for expansion to other units
Improved patient-staff relationships
Improved staff satisfaction
OPPORTINITIES
Fluctuating census
Noncompliance
THREATS

7. Rogers’ “Diffusion of Innovation”

8. IMPLEMENTATION/ACTIONS TAKEN
Microsystem assessment utilizing the 5 Ps
Chart and MAR review
Gap analysis
Process mapping
SWOT analysis
Fishbone diagram
Review of literature to include EBP and EBR
Staff education
Post implementation chart review
Ongoing education and support

9. GANTT CHART
GANTT CHART

10. PRE AND POST PROJECT DATA

11. CONCLUSIONS
As a result of this project, the staff members of 6A acute care have learned the benefits of using nonpharmacological approaches to manage challenging dementia-related behaviors. In addition, despite that they are still learning and practicing, they are utilizing those nonpharmacological approaches effectively and successfully. They are eager to try new approaches on patients with challenging dementia- related behaviors. Most importantly, they have come to understand the value of patient centered-care and the rewards that are gained by both patient and staff member.

12. REFERENCES
Cain, M., & Mittman, R. (2002). Diffusion of innovation in health care. Retrieved from
Ervin, K. E., Cross, M., & Koschel, A. (2013). Reducing the use of antipsychotics in dementia care through staff education and family participation. Journal of Nursing Education & Practice, 3(6), doi:
Casey, D. A. (2015). Pharmacotherapy of neuropsychiatric symptoms of dementia. Pharmacy and Therapeutics, 40(4), doi: dx.doi.org.ignacio.usfca.edu/ /arztebl
Karel, M. J., Teri, L., McConnell, E., Visnic, S., & Karlin, B. E. (2016). Effectiveness of expanded implementation of STAR-VA for managing dementia- related behaviors among veterans. The Gerontologist, 56(1), doi: /geront/gnv068
Robitaille, A., Garcia, L., & McIntosh, C. (2015). Joint trajectories of cognitive functioning and challenging behavior for persons living with dementia in long-term care. Psychology and Aging, 30(3), doi:
Steinberg, M., & Lyketsos, C. G. (2012). Atypical antipsychotic use in patients with dementia: Managing safety concerns. American Journal of Psychiatry, 169(9), doi:
World Health Organization. (2015). 10 facts on dementia. Retrieved from

13. ACKNOWLEDGEMENTS
Many thanks to Professor Francine Serafin-Dickson, MBS, BSN, CNL and all my past professors, and my mentor and always available preceptor Dianne Ragno, MSN, RN, CNL for their wealth of knowledge, guidance, and inspiration. A very special thank you to my husband, sons, family and friends for being patient and supportive over the past two and a half years. Without you standing selflessly behind me and cheering me on, this would not have been possible.