Assessment and non-pharmacological management among adults with a dementia diagnosis in a residential care setting: a best practice implementation project

BACKGROUND This evidence implementation project reports on a project conducted in the 17 bed special care unit of Symes Thorpe Residential Facility in Queensland, that focused on improving assessment and management of elderly residents diagnosed with dementia. The motivation for the project, and its value, should be understood in the context of a lack of a validated tool or standardized documentation being used to assess behaviors of residents diagnosed with dementia, as well as little targeted education being provided to staff on behaviour management strategies. OBJECTIVES To promote evidence based assessment and non-pharmacological management of challenging behavior in elderly adults living with dementia in a residential setting in Queensland. METHODS The project design was based on the Joanna Briggs Institute’s Practical Application of Clinical Evidence System and Getting Research into Practice audit and feedback tool. A baseline audit of care documentation in the 17 residents in the special care unit was conducted. Meetings were held with the project team to reflect on the findings of the baseline audit and plan strategies to improve practice. A validated tool, the Cohen-Mansfield Agitation Inventory, was introduced to improve assessment of patients together with a program of staff education to inform the use of the Inventory. A staff education program was introduced to improve staff awareness and use of strategies for behavior management of residents in the special care unit. Two follow up audits were conducted. The second audit was undertaken 3 months post introduction of the Cohen Mansfield Agitation Inventory and staff education program. RESULTS The follow up audits demonstrated 100% compliance in use of the Cohen Mansfield Agitation Inventory, and 100% staff attendance at education sessions. The audit also showed significant increase and improvement in quality of related resident care documentation, for example documenting outcomes of use of non-pharmacological therapy such as music, exercise, pets etc. CONCLUSIONS The findings show that a comprehensive education program can make an effective contribution to the understanding of challenging behaviors in dementia residents, and the associated documentation required to monitor them effectively.