Streamway BSO-RPN and NP present success story during Central East BSO meeting
Streamway Villa RPN-BSO Sarah Wilson and nurse practitioner (NP) Dmitri Goold presented a case study Oct. 27 focused on managing end-stage dementia and irreversible delirium during a Central East Local Health Integration Network (LHIN) Behavioural Supports Ontario (BSO) meeting on Oct. 27.
The focus of the study was a resident who lived at Streamway Villa, and how an integrated team effort from staff and managers at the Cobourg long-term care home helped enhance the resident’s quality of life.
At the beginning of the case study, Sarah and Dmitri discussed strategies the Streamway Villa team used to enhance the resident’s quality of life. For instance, they worked to control environmental noise as much as they could. The resident was given a private room and staff members would spend time with her outdoors in the courtyard, which the resident enjoyed.
The team also looked for individualized activities the resident enjoyed doing. Much of this was focused on things the resident had always enjoyed, such as doing laundry and note-taking, something the resident had done a lot of in her career.
“It was very important that we knew her past history,” Sarah says.
At the centre of the Streamway team’s success was the process map which is used in all long-term care homes in the Central East LHIN. The process map helps staff members make decisions on what to do when someone notices a change in a resident’s behaviour. The process map is aimed at standardizing care and helps staff members chart action plans to help residents.
“It takes you through step by step who does what and at what point,” Sarah explains.
Building on the strength of the process map, Streamway Villa used its morning huddles, which involve staff members from all departments, to discuss the resident’s care and to exchange ideas.
“We want all staff members to know they have the ability to recognize these things and how important it is to report any type of changes in a person,” Sarah says. “It was a big learning opportunity for all staff.”
The team involved the home’s dietitian to help with the care plan when the resident began losing weight. They also managed her pain. Sarah and Dmitri also discussed how the home utilized outside resources, such as the Geriatric Assessment Behavioural Unit (GABU) at the Peterborough Regional Health Centre. The GABU addresses responsive behaviours in long-term care residents with cognitive impairment and helps integrate people back into their home.
The resident’s family was also involved in the care plan, Sarah and Dmitri explained. Initially, the family had requested the resident use a wheelchair lap belt because of her high falling risk.
However, the lap belt caused the resident excessive agitation and responsive behaviours. The resident’s family was contacted and the home discussed removing the lap belt to allow the resident the freedom to walk.
The family agreed to this.
“The family was willing to accept the risk. Involving the family throughout the process was imperative to our success,” Sarah says. “Because the family was involved, they felt confident with the plan of care, and they didn’t leave with the guilt of second guessing that they could have if they didn’t feel confident in the plan of care.”
BSO is a provincial initiative to help enhance quality of life for seniors affected by dementia and other conditions that cause agitation. Funding from the initiative is provided to long-term care homes through Ontario’s 14 LHINs and is largely put towards staff education.
Through BSO, staff members can access education in evidence-based programs that reduce agitation for people with cognitive impairment, such as Montessori, the Gentle Persuasive Approach, and P.I.E.C.E.S. (physical, intellectual, emotional, capabilities, environment and social) training.
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