Transcript Intorducing the BC BPSD Algorithm

Elisabeth Antifeau, RN, MScN, GNC(C)
Community Integration Health Services
Practice Lead, Complex/Special Populations
and Palliative Care/End of Life.
Interior Health
Nelson, BC
Disclosure - Elisabeth
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Volunteer Director on the BC Psychogeriatric Association
Board since 2006 – currently holding the Practice Supports
Portfolio
June 2014 – Received an honorarium from Medical
Pharmacies Group Ltd. to deliver an unrestricted
educational event for residential nursing staff on the topic
of NON-pharmacological interventions for BPSD.
Within my IH role, I am the representative for Interior
Health on various provincial and cross agency working
groups addressing dementia, behaviours and system level
supports.
Dementia, Behaviours and Dilemmas
Elisabeth
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Getting on the same page about dementia, behaviours (BPSD) and dilemmas
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How big a problem is it?
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Principles of caring for people with BPSD
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What can be done? Approaches and tools…
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Highlights of the BPSD Algorithm www.bcbpsd.ca
Janice:
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Behavioural Support Planning
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Clinical example(s)
Questions and Answers – both presentations
Dementia – DSM-V
Mild to Major Neurocognitive Disorder due to:
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Alzheimer Disease
Lewy Body Disease
Frontotemporal lobar degeneration
Vascular Disease
Parkinson’s Disease etc.
With/Without Behavioural Disturbance
“Behavioural Disturbance”
A behavioural continuum ranging from mild to
severe that includes the following characteristics:
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Dangerous
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Distressing
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Damaging
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Disturbing
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Persistent
What is BPSD?
BPSD =
Behavioural and Psychological Symptoms of Dementia are the
neuropsychiatric symptoms that arise from advancing dementia:

Symptoms can include:
 Behaviours = wandering, verbal and physical aggression,
sexually or socially inappropriate, resisting care etc.
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Psychiatric = depression, delusions, psychosis, apathy
Symptoms will vary with the type and stage of dementia.
Terminology reflects the lens: paradigm shift is needed
“Challenging”, “Difficult” vs. “Responsive” Behaviours
How common is BPSD?
Evidence
Source
~30-35% of community-dwelling people with
dementia
(Lyketsos et al,
2000);
RAI-HC data indicates 7% of HCC clients trigger
behavioural CAP, not daily behaviours.
Focus is prevention.
RAI CAP manual
(2009), pg. 65-72
~80-90% of resident-dwelling people with
dementia
Margallo-Lana et al,
2001
RAI-2.0 data indicates 10% of residents trigger
daily behaviours.
Focus is to reduce the occurrence.
RAI CAP manual
(2009), pg. 65-72
(1/3 will improve in 90 days when care plan in place).
Why is BPSD Important?
 Quality
of Life issue
 Continuum
of Behavioral Escalation/cycling
 Resident/Visitor/Staff
 Staff
Safety
continuity/sustainability
Core Behavioral Principles
 Behaviours
are one of the 4 red flags in dementia care
that always needs further assessment:

pay attention to changes in behavior, function, thinking
and mood;
 ALL
Behaviour has meaning – sleuth it out
 Presume
 Avoid
changes are reversible until proven otherwise
diagnostic overshadowing
Core Behavioral Principles
 Don’t
take behaviour personally
 Target
one behaviour at a time
 Target
Antecedents<<BEHAVIOUR>>Consequences
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Be realistic: success is measured by decreases in
intensity, frequency and duration of behaviours,
rarely extinguishment.
Behavioural principles –

Integrated, wholistic, and personcentred approaches are needed**:
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Non-pharmacological
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Pharmacological
**Not a linear relationship
cont’d
Tools and Approaches
Approaches
 PIECES
 Gentle
Persuasion
Approach (GPA)
 Eden
Alternative
 Others
Tools
 BC
BPSD Algorithm
(2014)
 Behavioural
Support Plan
 Guidelines
Protocols
and
Never underestimate the therapeutic use of self
BC BPSD Algorithm - History and background
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2007-2009 –antipsychotic use in residential care is problematic
2011 – Ministry of Health provincial review = increased use of
antipsychotic drugs in res care
 2001/02 = was 37%
 April 2010 to June 2011 – rose to 50.3%
2012 – Ministry Res Care/BPSD guidelines developed
2013 - Provincial Working Group was struck to achieve
provincial consensus on all content within the algorithm.
2014 – electronic version released via the BC Patient Safety and
Quality Council website. Purchased domain “BC BPSD”
BC BPSD Algorithm Highlights:
 The
interactive algorithm is compatible
with multiple devices:
http://bcbpsd.ca/
BC BPSD Algorithm Highlights…
 PDF
vs. JPEG formats
 Branded
vs. No Logo
BC BPSD Algorithm Highlights:
 Opening
 Two
 Tool
•
•
Message
Parts
bars:
Screen Corners
Screen Bottom
Part One:
Interdisciplinary Decision Support for BPSD
Assessment
Problem
Solving
Care
Planning &
Evaluation
(focus on non-pharmacological interventions)
Part Two:
Reassessment with GP/NP
Assessment
Medication
Care
Options
Planning & Evaluation
(focus on layering in appropriate pharmacological interventions)
Summary
 Behaviour
•
•
•
•
is…
Responsive
Multifactorial
Complex
Quintessentially and
uniquely part of
being human
Addressing BPSD skillfully can improve quality of life.