Wyndham Manor BSO team reducing behaviours, antipsychotic administration

Interventions implemented by Wyndham Manor’s Behavioural Supports Ontario (BSO) team have helped the Extendicare long-term care home steadily decrease incidents of responsive behaviours and antipsychotic medication administration.

Between 2015 and 2016, antipsychotic administration declined from 32.36 per cent to 24.4 per cent, according to the home’s data. The most recent available data also shows the rate of responsive behaviours at the Oakville long-term care home decreased from 113 in January 2015 to 88 in March 2015.

BSO is a provincial initiative to help enhance quality of life for seniors affected by dementia and other conditions that cause agitation. The funding, which is provided to long-term care homes through Ontario’s 14 Local Health Integration Networks (LHINs), is largely put towards staff education.

Education the home’s BSO team has undertaken has been valuable to decreasing responsive behaviours and reducing antipsychotic medication administration, says Jonas Guerra, Wyndham’s Manor’s BSO registered practical nurse (RPN/BSO).

Through BSO training in programs like Gentle Persuasive Approaches, Guerra says team members have learned valuable best practices to enhance quality of life for residents while creating a safe environment for those living and working at Wyndham Manor.

Front-line staff members have also been educated on interventions developed by the BSO team along with training provided by psychogeriatric consultants from the Mississauga Halton LHIN.

There are individual success stories Guerra cites to illustrate BSO’s success at the home.

For instance, one resident who has Alzheimer’s disease as well as a delusional disorder was exhibiting serious responsive behaviours prior to interventions. These behaviours included physical and verbal aggressiveness, such as pushing and hitting, as well as resisting care and wandering.

BSO education helped the team identify triggers that would cause this resident’s responsive behaviours, which included noise, being disrobed while showering and being led by others when walking.

Looking into the resident’s history, they discovered he had been a businessman for many years. Staff began telling the resident there was a “meeting” shortly, which would prompt the gentleman to want to get showered and dressed. When staff members see the resident approaching a noisy area, they now persuade him to go for a walk in another direction, preventing him from being exposed to loud sounds. The resident has also benefited from the home’s dog therapy program, which has had a calming effect on him, Guerra says.

“As a result, the resident’s responsive behaviours are manageable and the risk of other residents or staff members becoming injured have considerably decreased,” Guerra says. “The family is also pleased with the care the resident is receiving.”

BSO interventions have benefited another resident who has a delusional disorder and suffers from depression. Before receiving BSO interventions, this resident was exhibiting responsive behaviours including hitting, scratching and throwing things as often as three times per day, says Malanie Bissessar, the BSO program’s personal support worker (PSW/BSO).

When agitated, the resident will speak in her native language, which few staff members understand. This was adding to the challenge, Bissessar says.

In assessing the resident, the BSO team found that awakening the resident too early in the morning, rushing her in any way or not responding immediately to her needs were some of the triggers prompting responsive behaviours.

To address this, the BSO team hosted several meetings with the resident’s family, front-line staff members and the home’s physician to update the resident’s care plan to prevent responsive behaviours.

The team implemented many changes based on the updated care plan.

Now, staff members let the resident sleep later into the morning. Staff members have been instructed on being aware of the value the resident places on care being provided care in a timely manner. Dietary staff accommodates the resident so she receives the specific meals she enjoys. Cue cards, which are posted on the resident’s wheelchair as well as in her room, have been created to translate words from the resident’s native language to English to minimize the language barrier.

These and other interventions have reduced the resident’s responsive behaviours, Bissessar says.

“(The BSO team) continues involvement, not only when (the resident expresses) responsive behaviours, but also during her calm moments to determine what was working well,” she says.

Guerra notes that what has made the BSO program so successful has been the team effort put forth from all departments – nursing, programs, physiotherapy, restorative care, dietary and housekeeping.

“Now that BSO is in place, staff has a better understanding and appreciation of what dementia care is all about; how their training and knowledge (garnered from BSO) has become an essential and vital tool in working with residents with responsive behaviours,” he says.