bpsd consensus algorithm: clear kick-off event
DESCRIPTION
This presentation was delivered by Elisabeth Antifeau at the kick-off event for CLeAR on October 9, 2013. Elisabeth is the home health integration lead, community integration for Interior Health. The aim of CLeAR – our Call for Less Antipsychotics in Residential Care – is to achieve a reduction in the number of seniors in residential care on antipsychotic medications by 50% across BC by December 31, 2014 through a province-wide, voluntary initiative that supports participating sites. Learn more at www.CLeARBC.ca.TRANSCRIPT
![Page 1: BPSD Consensus Algorithm: CLeAR Kick-Off Event](https://reader034.vdocuments.site/reader034/viewer/2022051514/548750f8b4af9f5f388b46ed/html5/thumbnails/1.jpg)
Call for Less Antipsychotics in Residential Care
CLeAR Kick-off EventOctober 9th, 2013
Elisabeth Antifeau, RN, MScN, GNC(C)
Behavioural and Psychological Symptoms of Dementia (BPSD)
Consensus Algorithm
![Page 2: BPSD Consensus Algorithm: CLeAR Kick-Off Event](https://reader034.vdocuments.site/reader034/viewer/2022051514/548750f8b4af9f5f388b46ed/html5/thumbnails/2.jpg)
BPSD: What is it?Behavioural and Psychological Symptoms of Dementia
Behavioural Symptoms
Psychological Symptoms
observable behaviours that are:
inappropriate or excessive within the situational context or setting;
disturbing, disruptive, distressing or potentially damaging to the person or others;
are: discrete or overt
mental disorders that commonly include, but are not limited to: depression, apathy, withdrawal, psychosis, etc.
![Page 3: BPSD Consensus Algorithm: CLeAR Kick-Off Event](https://reader034.vdocuments.site/reader034/viewer/2022051514/548750f8b4af9f5f388b46ed/html5/thumbnails/3.jpg)
BPSD: Why is it important?
BPSD is reported to affect 80-90% of people with dementia at some time in their disease course (Canadian Coalition for Seniors Mental Health (2006);
BPSD is a Quality of Life issue.
![Page 4: BPSD Consensus Algorithm: CLeAR Kick-Off Event](https://reader034.vdocuments.site/reader034/viewer/2022051514/548750f8b4af9f5f388b46ed/html5/thumbnails/4.jpg)
Background and History
December 2011 – BC MoH Review of antipsychotic drug use in residential care facilities;
Plan B (April to June 2010) indicated 50.3% residents (n=30,032) prescribed an antipsychotic.
Missing information: how long? for what condition?
2002, 2004, 2006, 2007 – Health Canada Advisories, about mortality risk and adverse reactions antipsychotic use - risperidone only approved med’n for BPSD use
June 2009 – CIHI Analysis in Brief released, 2006-07 data - 37.7% of seniors in nursing homes were using antipsychotic drugs (Manitoba, NB and P.E.I.)
![Page 5: BPSD Consensus Algorithm: CLeAR Kick-Off Event](https://reader034.vdocuments.site/reader034/viewer/2022051514/548750f8b4af9f5f388b46ed/html5/thumbnails/5.jpg)
History of the BPSD Algorithm
Original work written in 2010 for the Phased Dementia Pathway;
Best Practice Guidelines for Accommodating and Managing BPSD in Residential Care (Oct 2012);
Jan 2013 – August 2013: Consensus BPSD Algorithm Working Group
“The evidence indicates that successful management of BPSD requires care providers to understand and accommodate BPSD, not control it”.
IH Phased Dementia Pathway
![Page 6: BPSD Consensus Algorithm: CLeAR Kick-Off Event](https://reader034.vdocuments.site/reader034/viewer/2022051514/548750f8b4af9f5f388b46ed/html5/thumbnails/6.jpg)
What is the purpose of theBPSD Algorithm?
Simple, comprehensive one stop resource
An interactive and decisional resource tool to guide clinicians & physicians when faced with managing the behavioural and psychological symptoms of dementia;
Provides frontline clinicians & physicians with access to: Best Practice Recommendations for assessment, care-
planning and medications recommendations in a logical flow;
Evidence Based Assessment ToolsClinical References and information (e.g., which
behaviours respond to medications, and which don’t)
![Page 7: BPSD Consensus Algorithm: CLeAR Kick-Off Event](https://reader034.vdocuments.site/reader034/viewer/2022051514/548750f8b4af9f5f388b46ed/html5/thumbnails/7.jpg)
Part I: Interdisciplinary Decisional and Practice Support for BPSD:
•Assessment (green)
• Problem Solving (yellow)
• Care Planning (blue)
The Algorithm is meant to be used from the top down:
![Page 8: BPSD Consensus Algorithm: CLeAR Kick-Off Event](https://reader034.vdocuments.site/reader034/viewer/2022051514/548750f8b4af9f5f388b46ed/html5/thumbnails/8.jpg)
Part II: Reassessment with Family GP/NP for BPSD:
• Assessment (green)
•Medication Options (yellow)
•Monitoring (blue)
The Algorithm is meant to be used from the top down:
![Page 9: BPSD Consensus Algorithm: CLeAR Kick-Off Event](https://reader034.vdocuments.site/reader034/viewer/2022051514/548750f8b4af9f5f388b46ed/html5/thumbnails/9.jpg)
Decision Points…
At certain points along the Algorithm, users will encounter decision points identified as Diamonds…
These decision points pause the clinician to make a decision before correctly proceeding further down a pathway within the algorithm.
![Page 10: BPSD Consensus Algorithm: CLeAR Kick-Off Event](https://reader034.vdocuments.site/reader034/viewer/2022051514/548750f8b4af9f5f388b46ed/html5/thumbnails/10.jpg)
Walk through Algorithm
Page 1
Part I: Interdisciplinary Decisional and Practice Support for BPSD:AssessmentProblem SolvingCare Planning
Page 2
Reassessment with Family Physicians or Nurse Practitioner for BPSD:AssessmentMedication OptionsMonitoring
![Page 11: BPSD Consensus Algorithm: CLeAR Kick-Off Event](https://reader034.vdocuments.site/reader034/viewer/2022051514/548750f8b4af9f5f388b46ed/html5/thumbnails/11.jpg)
Part I: Interdisciplinary Decisional and Practice Support for BPSD
Identify and use the algorithm for the right population
Identify and priorize the urgency of the situation
Emergency pathwayNon-emergency pathway – tool selection
guide for assessment
![Page 12: BPSD Consensus Algorithm: CLeAR Kick-Off Event](https://reader034.vdocuments.site/reader034/viewer/2022051514/548750f8b4af9f5f388b46ed/html5/thumbnails/12.jpg)
Example1: Safetyescalation
continuum:anxietyagitationverbal/physical
aggression
staff approaches:attentiveresponsivedirective
![Page 13: BPSD Consensus Algorithm: CLeAR Kick-Off Event](https://reader034.vdocuments.site/reader034/viewer/2022051514/548750f8b4af9f5f388b46ed/html5/thumbnails/13.jpg)
Example2: Least RestraintsLink
Defining restraints
Differentiating chemical restraint versus treatment
Meets legislative requirements:Residential Care
Regulation S.74(1)a and S.77
![Page 14: BPSD Consensus Algorithm: CLeAR Kick-Off Event](https://reader034.vdocuments.site/reader034/viewer/2022051514/548750f8b4af9f5f388b46ed/html5/thumbnails/14.jpg)
Selecting the right assessment tool
Depression Screening Tools:GDS(15)CornellPHQ-9RAI-2.0 DRS
Cohen Mansfield Agitation Inventory (CMAI)
Dementia Observation Scale (DOS)
RAI-2.0Progress Notes
Differentiating 3DsRecognizing changes in usual thought,
mood, function, and behaviour as significant and important to probe and assess further
Selecting the right tool
![Page 15: BPSD Consensus Algorithm: CLeAR Kick-Off Event](https://reader034.vdocuments.site/reader034/viewer/2022051514/548750f8b4af9f5f388b46ed/html5/thumbnails/15.jpg)
Part I: Interdisciplinary Decisional and Practice Support for BPSD
Problem Solving focus using the PIECES Framework and A-B-C approach
Each link provides 1-2 page synopsis of evidence-based information to better understand multiple factors that contribute to behaviours
![Page 16: BPSD Consensus Algorithm: CLeAR Kick-Off Event](https://reader034.vdocuments.site/reader034/viewer/2022051514/548750f8b4af9f5f388b46ed/html5/thumbnails/16.jpg)
Example3: Common physical changes
Short and pithy, one page sources of informationLinks behaviour to wide variety of known causes using
PIECES – assists clinicians to appreciate multiple reasons for behavioural development
![Page 17: BPSD Consensus Algorithm: CLeAR Kick-Off Event](https://reader034.vdocuments.site/reader034/viewer/2022051514/548750f8b4af9f5f388b46ed/html5/thumbnails/17.jpg)
Part I: Interdisciplinary Decisional and Practice Support for BPSD
Create an individualized care planFirst Line intervention: non-pharmacological
interventionsOngoing monitoringWhen to seek (further) medical assistance
![Page 18: BPSD Consensus Algorithm: CLeAR Kick-Off Event](https://reader034.vdocuments.site/reader034/viewer/2022051514/548750f8b4af9f5f388b46ed/html5/thumbnails/18.jpg)
Part 2: Reassessment with GP or NP for BPSD
Re-assessment with medical lensPharmacological considerations: behaviour that
is dangerous, distressing, disturbing, and damaging/ & not responding
Distinguish behaviours that are/are not likely to respond to medications
![Page 19: BPSD Consensus Algorithm: CLeAR Kick-Off Event](https://reader034.vdocuments.site/reader034/viewer/2022051514/548750f8b4af9f5f388b46ed/html5/thumbnails/19.jpg)
Example4:Behaviours that are not like to respond to medications
Resistiveness to care“…the repertoire of behaviours with which
persons with dementia withstand or oppose the efforts of a caregiver”
(Mahoney et al)
![Page 20: BPSD Consensus Algorithm: CLeAR Kick-Off Event](https://reader034.vdocuments.site/reader034/viewer/2022051514/548750f8b4af9f5f388b46ed/html5/thumbnails/20.jpg)
Example5Resistiveness to Care Scale
![Page 21: BPSD Consensus Algorithm: CLeAR Kick-Off Event](https://reader034.vdocuments.site/reader034/viewer/2022051514/548750f8b4af9f5f388b46ed/html5/thumbnails/21.jpg)
Part 2: Reassessment with GP or NP for BPSD
Behaviours that may respond to medicationsSecond-line intervention support Evidence-informed behavioural categories:
sleep disturbance, anxiety, psychosis, aggression, depression and sexually inappropriate behaviour.
![Page 22: BPSD Consensus Algorithm: CLeAR Kick-Off Event](https://reader034.vdocuments.site/reader034/viewer/2022051514/548750f8b4af9f5f388b46ed/html5/thumbnails/22.jpg)
Page 1 – Medication Templates
![Page 23: BPSD Consensus Algorithm: CLeAR Kick-Off Event](https://reader034.vdocuments.site/reader034/viewer/2022051514/548750f8b4af9f5f388b46ed/html5/thumbnails/23.jpg)
Page 2 – Medication Templates
Key Messages and considerations:Start low and go slow;Strive for a good clinical trialdrug-specific cautionsorder of decreasing side-effects within a
class linkage with CCDTD4(2012)
recommendationscautions for renal/hepatic clientstitration and weaning information
References and other medication information
![Page 24: BPSD Consensus Algorithm: CLeAR Kick-Off Event](https://reader034.vdocuments.site/reader034/viewer/2022051514/548750f8b4af9f5f388b46ed/html5/thumbnails/24.jpg)
Part 2: Reassessment with GP or NP for BPSD
Monitoring effectiveness of treatment, side effectsContinued integration with non-pharm strategies in care
planReassessing the need for continued therapy, exploring
discontinuing therapyMonitoring for recurrence/emergence of BPSD
![Page 25: BPSD Consensus Algorithm: CLeAR Kick-Off Event](https://reader034.vdocuments.site/reader034/viewer/2022051514/548750f8b4af9f5f388b46ed/html5/thumbnails/25.jpg)
Next steps…
This Fall 2013:
Alpha testing (testing, QA, usability testing)
Beta launch (pilot site to trial)
Deployment – announcement and ready for use
![Page 26: BPSD Consensus Algorithm: CLeAR Kick-Off Event](https://reader034.vdocuments.site/reader034/viewer/2022051514/548750f8b4af9f5f388b46ed/html5/thumbnails/26.jpg)
Making the algorithm available
BCPSQC website
Personal Computer
Tablets
App for Smart & Android Phones
![Page 27: BPSD Consensus Algorithm: CLeAR Kick-Off Event](https://reader034.vdocuments.site/reader034/viewer/2022051514/548750f8b4af9f5f388b46ed/html5/thumbnails/27.jpg)
Smart Phone/Android version
BCBPSD.ca domainwill look differentstill guided by
colourQuick Links MenuChart ViewSave the PageNavigation BarFavourites Point-Click-Print
capacity
![Page 28: BPSD Consensus Algorithm: CLeAR Kick-Off Event](https://reader034.vdocuments.site/reader034/viewer/2022051514/548750f8b4af9f5f388b46ed/html5/thumbnails/28.jpg)
![Page 29: BPSD Consensus Algorithm: CLeAR Kick-Off Event](https://reader034.vdocuments.site/reader034/viewer/2022051514/548750f8b4af9f5f388b46ed/html5/thumbnails/29.jpg)
Implementation Planning – IntentBPSD Guideline 2012BPSD Algorithm 2013-14
Education – promoting integration of both BPSD tools with various other initiatives across BC: Revised GPAC guidelines (Cognitive Impairment in the
Elderly) will reinforce BPSD tools, approach, e.g.,
use of CAM-PRISME in deliriumuse of GDS-15; Cornell, for depression, etc
Caring JourneyGentle Persuasion training
PIECES implementation and training events provincially (2013-14)
Anticipated Fall to
Winter 2013 Delivery
![Page 30: BPSD Consensus Algorithm: CLeAR Kick-Off Event](https://reader034.vdocuments.site/reader034/viewer/2022051514/548750f8b4af9f5f388b46ed/html5/thumbnails/30.jpg)
Acknowledgements