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ATX31 - "Just Say "NO" to Drugs….and "YES" to Successful Behavior Management"

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Texas Health Care Association
Texas Health Care Association

The document discusses falls prevention in long-term care facilities. It outlines that facilities must ensure residents' environments are free of hazards and that residents receive adequate supervision and assistance to prevent accidents. It describes methods to identify, evaluate, and address hazards and risks to reduce accidents. It also discusses defining avoidable versus unavoidable accidents and the need for facilities to demonstrate commitment to safety.

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JUST SAY “NO” TO DRUGS & “YES” TO SUCCESSFUL BEHAVIOR MANAGMENT OLD BELIEFS Sneezes CPR F323 - REGULATIONS SUPPORT - 8/14/07 THE FACILITY MUST ENSURE THAT The resident environment remains as free of accident hazards as is possible; and Each resident receives adequate supervision and assistance devices to prevent accidents. METHOD TO MEET INTENT Identifying hazards and risks; Evaluating and analyzing hazards and risks; Implementing interventions to reduce hazards and risks; and Monitoring for effectiveness and modifying interventions as indicated. AVOIDABLE ACCIDENT Facility failed to: Identify environmental hazard and resident risk Evaluate/analyze hazard and risk implement interventions Monitor and modify interventions as needed Presented by: Diana Waugh, BSN, RN November 6, 2013! ! ! ! !! ! ! ! ! ! ! ! ! ! ! ! THCA Page 1
F323, cont... UNAVOIDABLE ACCIDENT Accident occurred despite facility’s efforts to: Identify environmental hazard and resident risk Evaluate/analyze hazard and risk implement interventions Monitor and modify interventions as needed COMMITMENT TO SAFETY A facility with a commitment to safety: Identifies risk Reports risk Involves all staff Utilizes resources Commitment to safety demonstrated at all levels of organization RESIDENT RISKS -Falls are defined as unintentionally coming to rest on the ground, floor, or other lower level, but not as a result of an overwhelming external force. -An episode where a resident loses his/her balance and would have fallen, if not for staff intervention, is considered a fall. -A fall without injury is still a fall. ADEQUATE SUPERVISION The lack of adequate supervision to prevent accidents occurs when the facility has: Failed to accurately assess a resident and/or the resident environment to determine whether supervision to avoid an accident or injury was necessary; and/or Determined supervision of the resident or resident environment was necessary, but failed to provide it. Presented by: Diana Waugh, BSN, RN November 6, 2013! ! ! ! !! ! ! ! ! ! ! ! ! ! ! ! THCA Page 2
F323, cont... DEFICIENCY CATEGORIZATION SEVERITY LEVEL 4 CONSIDERATIONS Examples of Level 4 might include: Fracture or other injury that may require surgical intervention and results in significant decline in mental and/or physical functioning; DEFICIENCY CATEGORIZATION SEVERITY LEVEL 3 CONSIDERATIONS Examples of Level 3 might include: Fracture or other injury that may require surgical intervention and does not result in significant decline in mental and/or physical functioning; RESTRAINTS: AN OLD STORY 1600 1700 1800 1900 2000 2012 - Bedlam Chairs, straitjackets Boxes all of the above all of the above & Psychological Restraints all of the above & Chemical Restraints (1990!) THE MYTH We don’t know what else to do! THE TRUTH WE DO! Presented by: Diana Waugh, BSN, RN November 6, 2013! ! ! ! !! ! ! ! ! ! ! ! ! ! ! ! THCA Page 3
THE SUPPORTING GOALS AND BELIEFS Life=Purpose Plagues of the Elderly Boredom Loneliness Helplessness A Fall and Motivation The Ultimate Falls Reduction Belief “ANSWERS TO FALLS MITIGATION LIES IN YOUR ABILITY TO LOOK INSIDE OF THE RESIDENT’S REALITY - - - - NOT SOLELY AT EXTERNAL “THINGS” STAFF GOAL MUST BE “TO DETERMINE THE RESIDENT’S GOAL FOR MOVING OR GETTING UP AND THEN HELPING THEM MEET IT.” CHALLENGING BEHAVIOR Whose Problem Is it? What is Non-compliance? WHERE HAVE YOU BEEN? How do you see you role in falls mitigation? Presented by: Diana Waugh, BSN, RN November 6, 2013! ! ! ! !! ! ! ! ! ! ! ! ! ! ! ! THCA Page 4
Where, cont.... What does the Falls Qa Data Show? How have you utilized it? What global interventions have been put into place based on that data? When a resident falls, who is responsible for determining the changes to the care plan, if any are required? What is the role of your falls committee? How does that information get disseminated? Is there a mechanism so that every employee working the next shift knows the change/addition in the interventions? If I asked all staff why folks are still falling, what would they say? Are social interventions offered? Name three you see in place today. Are social interventions valued? Relate one instance where you rewarded another staff member for trying to use a social intervention. Preferably this would be a front line staff member, a charge nurse or a floor nurse. Do you feel you falls SHOULD be less? Why? Why not? Do you feel your falls COULD be less? Why? Why not? Who on the staff is doing a great job as part of the solution? How have you utilized their talents with the remaining staff in education, example, hands on demonstration? Who on staff continues to be part of the problem? Why? What is stopping them from becoming part of the solution? Presented by: Diana Waugh, BSN, RN November 6, 2013! ! ! ! !! ! ! ! ! ! ! ! ! ! ! ! THCA Page 5
FACILITY ACTIONS 1. Has the pre-admission assessment proved successful? Why? Why not? 2. Does the management team demonstrate support of the physical, chemical and psychological restraint freedom philosophy? 3. Has the facility formulated and committed to paper their philosophy regarding freedom from all types of restraints? 4. Is that restraint freedom philosophy shared during preadmission and admission discussion? 5. Does the facility meet with the families/responsible parties to provide information on refusal to use restraints? 6. Has the facility included their philosophy in the resident handbook? 7. Does the facility utilize their philosophy when interviewing and hiring new employees? 8. Does orientation/training of new staff include restraint philosophy information? 9. Can all staff 1) Define a restraint; 2) State the dangers of restraints; 3) List ways to determine alternatives and give at least 3 resident-specific examples of alternatives? Presented by: Diana Waugh, BSN, RN November 6, 2013! ! ! ! !! ! ! ! ! ! ! ! ! ! ! ! THCA Page 6
Facility Action.... 10. Does the facility assessments address all types of restraints physical, chemical and psychological: 1) How restraint use will assist resident in reaching his/her highest level of physical and psycho social well-being; 2) Increase independence and function, 3) Provide the resident with a purpose to live; 4. Medical symptoms supporting restraint use; and 5) Cognitive functional age. 11. Have all confused residents been assessed for safety with siderails? 12. Are restraints applied and monitored only by professional staff members? 13. Do you use Fall Classes, Tai Chi, extended wear briefs CAUSES OF BEHAVIORS Physical/Emotional Health Environmental Causes, cont... Task Specific Communication Presented by: Diana Waugh, BSN, RN November 6, 2013! ! ! ! !! ! ! ! ! ! ! ! ! ! ! ! THCA Page 7
Assessment of Behaviors Eleven W’s WHO has the challenge WHAT is the challenge WHY address it WHAT happens before WHERE does it happen WHAT does it mean WHEN does it occur WHAT is the pattern WHO is around when it happens WHAT is the usual outcome WHAT is the desired outcome ABCs Antecedents to Behavior Behavior Consequences Presented by: Diana Waugh, BSN, RN November 6, 2013! ! ! ! !! ! ! ! ! ! ! ! ! ! ! ! THCA Page 8
Social Assessment What does the resident like to: See Smell Taste Touch Hear Three stories that make the resident happy Three topics/issues that make the resident unhappy What was their favorite chair before they came to the facility Where were they sleeping before they came to the facility RESIDENT STRENGTHS Non-thinking Behaviors Physical Activities Hoarding Long Term Memory Sense of Rhythm Sense of Humor Presented by: Diana Waugh, BSN, RN November 6, 2013! ! ! ! !! ! ! ! ! ! ! ! ! ! ! ! THCA Page 9
REFERENCES AHCA 800.321.0343 “EVERYBODY WINS” video series ALLEN-COGNITIVE LEVELS www.allen-cognitive-levels.com GROW COALITION -Getting Residents Out of Wheelchairs www.GROWcoalition.org THE KENDAL CORPORATION 610.388.5580 Printed materials NCCNHR; 202.332.2275 - Avoiding Restraint Use booklets RCCT and BRAIN STIMULATING PROGRAMS Barbara Brock 419.865.6131 WWW.clocktestrcct.com Presented by: Diana Waugh, BSN, RN November 6, 2013! ! ! ! !! ! ! ! ! ! ! ! ! ! ! ! THCA Page 10
BEHAVIOR MANAGEMENT WORK SHEET Behavior: _______________________________________________ _______________________________________________ ____________________________________________ Current Interventions: _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ New Interventions: _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ Presented by: Diana Waugh, BSN, RN November 6, 2013! ! ! ! !! ! ! ! ! ! ! ! ! ! ! ! THCA Page 11

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ATX31 - "Just Say "NO" to Drugs….and "YES" to Successful Behavior Management"

  • 1. JUST SAY “NO” TO DRUGS & “YES” TO SUCCESSFUL BEHAVIOR MANAGMENT OLD BELIEFS Sneezes CPR F323 - REGULATIONS SUPPORT - 8/14/07 THE FACILITY MUST ENSURE THAT The resident environment remains as free of accident hazards as is possible; and Each resident receives adequate supervision and assistance devices to prevent accidents. METHOD TO MEET INTENT Identifying hazards and risks; Evaluating and analyzing hazards and risks; Implementing interventions to reduce hazards and risks; and Monitoring for effectiveness and modifying interventions as indicated. AVOIDABLE ACCIDENT Facility failed to: Identify environmental hazard and resident risk Evaluate/analyze hazard and risk implement interventions Monitor and modify interventions as needed Presented by: Diana Waugh, BSN, RN November 6, 2013! ! ! ! !! ! ! ! ! ! ! ! ! ! ! ! THCA Page 1
  • 2. F323, cont... UNAVOIDABLE ACCIDENT Accident occurred despite facility’s efforts to: Identify environmental hazard and resident risk Evaluate/analyze hazard and risk implement interventions Monitor and modify interventions as needed COMMITMENT TO SAFETY A facility with a commitment to safety: Identifies risk Reports risk Involves all staff Utilizes resources Commitment to safety demonstrated at all levels of organization RESIDENT RISKS -Falls are defined as unintentionally coming to rest on the ground, floor, or other lower level, but not as a result of an overwhelming external force. -An episode where a resident loses his/her balance and would have fallen, if not for staff intervention, is considered a fall. -A fall without injury is still a fall. ADEQUATE SUPERVISION The lack of adequate supervision to prevent accidents occurs when the facility has: Failed to accurately assess a resident and/or the resident environment to determine whether supervision to avoid an accident or injury was necessary; and/or Determined supervision of the resident or resident environment was necessary, but failed to provide it. Presented by: Diana Waugh, BSN, RN November 6, 2013! ! ! ! !! ! ! ! ! ! ! ! ! ! ! ! THCA Page 2
  • 3. F323, cont... DEFICIENCY CATEGORIZATION SEVERITY LEVEL 4 CONSIDERATIONS Examples of Level 4 might include: Fracture or other injury that may require surgical intervention and results in significant decline in mental and/or physical functioning; DEFICIENCY CATEGORIZATION SEVERITY LEVEL 3 CONSIDERATIONS Examples of Level 3 might include: Fracture or other injury that may require surgical intervention and does not result in significant decline in mental and/or physical functioning; RESTRAINTS: AN OLD STORY 1600 1700 1800 1900 2000 2012 - Bedlam Chairs, straitjackets Boxes all of the above all of the above & Psychological Restraints all of the above & Chemical Restraints (1990!) THE MYTH We don’t know what else to do! THE TRUTH WE DO! Presented by: Diana Waugh, BSN, RN November 6, 2013! ! ! ! !! ! ! ! ! ! ! ! ! ! ! ! THCA Page 3
  • 4. THE SUPPORTING GOALS AND BELIEFS Life=Purpose Plagues of the Elderly Boredom Loneliness Helplessness A Fall and Motivation The Ultimate Falls Reduction Belief “ANSWERS TO FALLS MITIGATION LIES IN YOUR ABILITY TO LOOK INSIDE OF THE RESIDENT’S REALITY - - - - NOT SOLELY AT EXTERNAL “THINGS” STAFF GOAL MUST BE “TO DETERMINE THE RESIDENT’S GOAL FOR MOVING OR GETTING UP AND THEN HELPING THEM MEET IT.” CHALLENGING BEHAVIOR Whose Problem Is it? What is Non-compliance? WHERE HAVE YOU BEEN? How do you see you role in falls mitigation? Presented by: Diana Waugh, BSN, RN November 6, 2013! ! ! ! !! ! ! ! ! ! ! ! ! ! ! ! THCA Page 4
  • 5. Where, cont.... What does the Falls Qa Data Show? How have you utilized it? What global interventions have been put into place based on that data? When a resident falls, who is responsible for determining the changes to the care plan, if any are required? What is the role of your falls committee? How does that information get disseminated? Is there a mechanism so that every employee working the next shift knows the change/addition in the interventions? If I asked all staff why folks are still falling, what would they say? Are social interventions offered? Name three you see in place today. Are social interventions valued? Relate one instance where you rewarded another staff member for trying to use a social intervention. Preferably this would be a front line staff member, a charge nurse or a floor nurse. Do you feel you falls SHOULD be less? Why? Why not? Do you feel your falls COULD be less? Why? Why not? Who on the staff is doing a great job as part of the solution? How have you utilized their talents with the remaining staff in education, example, hands on demonstration? Who on staff continues to be part of the problem? Why? What is stopping them from becoming part of the solution? Presented by: Diana Waugh, BSN, RN November 6, 2013! ! ! ! !! ! ! ! ! ! ! ! ! ! ! ! THCA Page 5
  • 6. FACILITY ACTIONS 1. Has the pre-admission assessment proved successful? Why? Why not? 2. Does the management team demonstrate support of the physical, chemical and psychological restraint freedom philosophy? 3. Has the facility formulated and committed to paper their philosophy regarding freedom from all types of restraints? 4. Is that restraint freedom philosophy shared during preadmission and admission discussion? 5. Does the facility meet with the families/responsible parties to provide information on refusal to use restraints? 6. Has the facility included their philosophy in the resident handbook? 7. Does the facility utilize their philosophy when interviewing and hiring new employees? 8. Does orientation/training of new staff include restraint philosophy information? 9. Can all staff 1) Define a restraint; 2) State the dangers of restraints; 3) List ways to determine alternatives and give at least 3 resident-specific examples of alternatives? Presented by: Diana Waugh, BSN, RN November 6, 2013! ! ! ! !! ! ! ! ! ! ! ! ! ! ! ! THCA Page 6
  • 7. Facility Action.... 10. Does the facility assessments address all types of restraints physical, chemical and psychological: 1) How restraint use will assist resident in reaching his/her highest level of physical and psycho social well-being; 2) Increase independence and function, 3) Provide the resident with a purpose to live; 4. Medical symptoms supporting restraint use; and 5) Cognitive functional age. 11. Have all confused residents been assessed for safety with siderails? 12. Are restraints applied and monitored only by professional staff members? 13. Do you use Fall Classes, Tai Chi, extended wear briefs CAUSES OF BEHAVIORS Physical/Emotional Health Environmental Causes, cont... Task Specific Communication Presented by: Diana Waugh, BSN, RN November 6, 2013! ! ! ! !! ! ! ! ! ! ! ! ! ! ! ! THCA Page 7
  • 8. Assessment of Behaviors Eleven W’s WHO has the challenge WHAT is the challenge WHY address it WHAT happens before WHERE does it happen WHAT does it mean WHEN does it occur WHAT is the pattern WHO is around when it happens WHAT is the usual outcome WHAT is the desired outcome ABCs Antecedents to Behavior Behavior Consequences Presented by: Diana Waugh, BSN, RN November 6, 2013! ! ! ! !! ! ! ! ! ! ! ! ! ! ! ! THCA Page 8
  • 9. Social Assessment What does the resident like to: See Smell Taste Touch Hear Three stories that make the resident happy Three topics/issues that make the resident unhappy What was their favorite chair before they came to the facility Where were they sleeping before they came to the facility RESIDENT STRENGTHS Non-thinking Behaviors Physical Activities Hoarding Long Term Memory Sense of Rhythm Sense of Humor Presented by: Diana Waugh, BSN, RN November 6, 2013! ! ! ! !! ! ! ! ! ! ! ! ! ! ! ! THCA Page 9
  • 10. REFERENCES AHCA 800.321.0343 “EVERYBODY WINS” video series ALLEN-COGNITIVE LEVELS www.allen-cognitive-levels.com GROW COALITION -Getting Residents Out of Wheelchairs www.GROWcoalition.org THE KENDAL CORPORATION 610.388.5580 Printed materials NCCNHR; 202.332.2275 - Avoiding Restraint Use booklets RCCT and BRAIN STIMULATING PROGRAMS Barbara Brock 419.865.6131 WWW.clocktestrcct.com Presented by: Diana Waugh, BSN, RN November 6, 2013! ! ! ! !! ! ! ! ! ! ! ! ! ! ! ! THCA Page 10
  • 11. BEHAVIOR MANAGEMENT WORK SHEET Behavior: _______________________________________________ _______________________________________________ ____________________________________________ Current Interventions: _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ New Interventions: _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ Presented by: Diana Waugh, BSN, RN November 6, 2013! ! ! ! !! ! ! ! ! ! ! ! ! ! ! ! THCA Page 11