1.  Bette Jo Tunks RN  Carol Ward MD BCPGA Conference Kamloops, BC April 24, 2015 BJ Tunks & C Ward Tertiary Mental Health IHA

2.  Faculty: Bette Jo Tunks and Carol Ward  Relationships with commercial interests: ◦ Grants/Research Support: Nil ◦ Speakers Bureau/Honoraria: Nil ◦ Consulting Fees: Nil ◦ Other: Nil  This program has received no in-kind support from outside organizations BJ Tunks & C Ward Tertiary Mental Health IHA

3. The learner will be able to: ◦ Describe the purpose of the P.I.E.C.E.S.™ learning and development program and its role-out in BC ◦ List some of the key outcomes of this educational initiative ◦ Reference the BC Dementia Plan Update to better understand the goals for enhancing care in persons with dementia in the province BJ Tunks & C Ward Tertiary Mental Health IHA

4. “Only after we understand the behaviour can we meaningfully manage the problem” (P.I.E.C.E.S.™ Consultation Team 02-10-03) BJ Tunks & C Ward Tertiary Mental Health IHA

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6. P.I.E.C.E.S.™ 6 th Ed. A Model for Collaborative Care and Changing Practice

7. Common vision Common language Common approach BJ Tunks & C Ward Tertiary Mental BJ Tunks & C Ward Tertiary Mental Health IHA BJ Tunks & C Ward Tertiary Mental Health IHA Health IHA

8.  What has changed? Think atypical  What are the RISKS & possible causes? Think P.I.E.C.E.S.™  What is the Action? BJ Tunks & C Ward Tertiary Mental Health IHA

9. BJ Tunks & C Ward Tertiary Mental Health IHA Physical Intellectual Emotional Capabilities Environment Social

10.  Regulated Health Care Professionals (RN, RPN, NP, OT, PT, SW)  Health Care programs and organizations (internal and external BJ Tunks & C Ward Tertiary Mental Health IHA

11. Individuals with complex physical, cognitive/mental health needs and behaviour changes. BJ Tunks & C Ward Tertiary Mental Health IHA

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14.  Kamloops Integrated P.I.E.C.E.S. Initiative and P.I.E.C.E.S. ™ Leadership & Performance Improvement program  IHA Residential Care  Provincial Residential Care  Tertiary Older Adult P.I.E.C.E.S. Initiative BJ Tunks & C Ward Tertiary Mental Health IHA

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17. Placement, Drugs and Therapy… We Can Do Better www.seniorsadvocatebc.ca BJ Tunks & C Ward Tertiary Mental Health IHA

18. BJ Tunks & C Ward Tertiary Mental Health IHA More than one-third of B.C. seniors in long-term care prescribed antipsychotic drugs: advocate Medication often used for dementia patients although it was created for psychiatric illnesses

19. BJ Tunks & C Ward Tertiary Mental Health IHA  Drs. Donnelly/McElhaney – focus group/review of healthcare professionals/caregivers and their opinions for improving care Acute CareER Person centered approach Triage 48/5Screen for delirium Consumer feedback Assess behaviours’ origins & follow standard approaches to management Least restraintCaregivers Assess and manage behaviours Educate

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21.  Staff education, training & coaching  Develop practical evidence-based resources  Use of quality indicators & evaluation (Collett et al. 2009, Moyle et al. 2010, Gibson et al. 2010) C Ward Tertiary Mental Health IHA

22. E Drance & C Ward 2015 Translating Knowledge Shared Solution Finding Team Collaboration Acting Together

23.  P.I.E.C.E.S.™ (2012-current) ◦ Kamloops Integrated P.I.E.C.E.S. TM Initiative ◦ BC Residential Care ◦ BC Tertiary Older Adult Mental Health  BC BPSD Guidelines 2013  BC BPSD Algorithm 2014  Dementia Action Plan Update 2015 BJ Tunks & C Ward Tertiary Mental Health IHA

24.  Expands on 2012 plan  Attempts to provide a comprehensive approach for the person with dementia from diagnosis to end of life  Organised four areas of care * ◦ Staying healthy ◦ Getting better ◦ Living with illness and disability ◦ Coping with end of life * BC Patient Safety & Quality Council BJ Tunks & C Ward Tertiary Mental Health IHA

25. BJ Tunks & C Ward Tertiary Mental Health IHA  Implementation of actions will be phased in over 2015-2018  In next year focus on wandering and increasing public awareness  Begin planning on increasing training of health care professionals across all appropriate sectors

26. BJ Tunks & C Ward Tertiary Mental Health IHA 4 Priorities  Increasing public awareness and early recognition  Supporting individuals to live independently and safely  Improving the quality of care in residential care facilities and improving palliative and end-of-life care  Increasing system support and adoption of best practice in dementia care

27. BJ Tunks & C Ward Tertiary Mental Health IHA  MOH acknowledges the good uptake of P.I.E.C.E.S.™ and the use of the BC BPSD guidelines and algorithm (www.bcbpsd.ca) in the province to date  MOH collaboration on evaluation of current P.I.E.C.E.S.™ initiatives: ◦ Educator surveys ◦ Post-evaluation 24 Hour Program ◦ Inter-RAI

28.  Gentle Persuasive Approach (GPA) ◦ Interior Health Authority ◦ Vancouver Coastal Health ◦ Providence Health Care  iLearn modules  Integrating Care Approaches for Complex Behaviours  4 hr workshop for Physicians  Dementia-related Responsive Behaviours: Putting It Altogether using P.I.E.C.E.S.™ TM and the BC BPSD Algorithm (pilot, April 25, 2015)  Other  CLeAR report 2015  Dementia: Understanding risks and preventing violence [Worksafe BC] BJ Tunks & C Ward Tertiary Mental Health IHA

29.  BC Patient Safety & Quality Council ◦ Call for Less Antipsychotic Use in Residential Care (CLeAR) ◦ Clck web-site  UBC Tertiary Older Adult P.I.E.C.E.S.™ Initiative ◦ Project Lead: Dr. Mary Lou Harrigan ◦ P.I.E.C.E.S.™ Newsletter BJ Tunks & C Ward Tertiary Mental Health IHA

30.  Commitment by MOH and Health Authorities  Funding- P.I.E.C.E.S.™ licences terminate March 2016 unless renewed  Fostering collaboration  Evaluation outcomes BJ Tunks & C Ward Tertiary Mental Health IHA

31. Leadership Lessons from Dancing Guy BJ Tunks & C Ward Tertiary Mental Health IHA

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