Introduction Fairview Nursing Home is amongst the largest in Aberdeen, with 114 beds 30 of which are...
1
Introduction Fairview Nursing Home is amongst the largest in Aberdeen, with 114 beds 30 of which are in the EMI unit, but has one of the lowest, relatively, antipsychotic prescribing rates in Grampian. In April 2012 there were 6 residents (from a population of 102) on antipsychotics and in May 2013 there were 5. This is a considerable reduction from March 2008 when the number of patients in the 28 bed EMI unit alone was 11. The Butterfly Approach - A Person Centred Approach to Dementia Care Dr Damian McGrory, Danestone Medical Practice, Aberdeen 2013 The staff also took part in the “Being a Star” programme which highlighted the “Butterfly Approach” to dementia. Essentially, this approach involves five principles and is based on a metaphor of a butterfly which can flit around a room or be still (it may have been inspired by the Dolly Parton song “Love is like a Butterfly” ) 1) Butterflies know themselves and work from feelings, from their spirit on the inside and not just from doing. 2) Butterflies need environments to be full of things stuff to use with masses of rummage items around. 3) Butterflies know how to be good at both flitting creating 30 second activities but also are good at being still. 4) Butterflies get rid of all negative and controlling care. 5) Butterflies need groups of people at similar points in their journey of a dementia to be matched together to enable a clear focus. This essentially meant a change in the Home’s environment, ie: it was filled with things for patients to do, corridors had memoirs for the patients’ lives, and generally became brighter and less clinical. Results As a result of these changes, Fairview not only used less antipsychotic medication halving the rate in 4 years, it also demonstrably improved its care rating. It initially scored a level 5 with scores comparable to below. Positive Score Neutral Score Negative Scores 30% 60% 10% To a level 2 Positive Score Neutral Score Negative Scores 60% 40% 0% Aim To review the training the Fairview staff undertook to bring about such a change. Methods The staff at Fairview initially used an observational tool, Quality of Interaction Schedule (QUIS) to record patients interactions with the staff at 5 minute intervals. The interactions were then graded into categories ranging from the most beneficial “Positive Social” to the most oppressive “Negative Restrictive”. Areas requiring improvement were highlighted, acted upon and the observing process repeated. Below is an example of how interactions were graded into the various categories. Conclusions I have learnt the importance of becoming more person-centred in my approach to helping those with dementia. To this end, the GPs attending Fairview have taken on board these principles and now study behavioural charts, ask how the staff interact with patients and look to see if any reversible causes of a decline in behaviour. References Aberdeen city CHP (2009).Review of antipsychotic prescribing with care homes for patients with dementia. Rae M. (2010). Being a star evaluation report. Dementia Matters/Barchester Health Care. Barchester Healthcare (2012). Living disability services, the lived experience audit. Barchester Health Care Sheard D.(2010).http://www.dementiacarematters.com/pdf/OTnews20 10.pdf. Dementia Matters. Positive Social Positive Care Neutral Negative Protecti ve Negative restrictiv e Touching Complemen t a resident Setting right atmospher e Sharing photos Sharing feelings Encourage residents to talk about their feelings. Sing songs Including residents in conversatio ns Assisting with choices-ie clothing Joining in with resident’s hobbies Talk to families Giving a resident no choice in clothing. Not informing residents in what’s about to happen Giving out food without talking Talking about residents not to them. Telling someone what not to do Limiting environme nt to keep it safe. Putting patients in wheelchairs instead of waiting for them Making a person wait for the tea trolley- they could try and make a cup of tea herself. Feeding inappropria tely- too messy.
-
Upload
malcolm-goodman -
Category
Documents
-
view
217 -
download
0
Transcript of Introduction Fairview Nursing Home is amongst the largest in Aberdeen, with 114 beds 30 of which are...
Introduction
Fairview Nursing Home is amongst the largest in Aberdeen, with 114 beds 30 of which are in the EMI unit, but has one of the lowest, relatively, antipsychotic prescribing rates in Grampian. In April 2012 there were 6 residents (from a population of 102) on antipsychotics and in May 2013 there were 5. This is a considerable reduction from March 2008 when the number of patients in the 28 bed EMI unit alone was 11.
The Butterfly Approach - A Person Centred Approach to Dementia CareDr Damian McGrory, Danestone Medical Practice, Aberdeen 2013
The staff also took part in the “Being a Star” programme which highlighted the “Butterfly Approach” to dementia. Essentially, this approach involves five principles and is based on a metaphor of a butterfly which can flit around a room or be still (it may have been inspired by the Dolly Parton song “Love is like a Butterfly” )
1) Butterflies know themselves and work from feelings, from their spirit on the inside and not just from doing.
2) Butterflies need environments to be full of things stuff to use with masses of rummage items around.
3) Butterflies know how to be good at both flitting creating 30 second activities but also are good at being still.
4) Butterflies get rid of all negative and controlling care.
5) Butterflies need groups of people at similar points in their journey of a dementia to be matched together to enable a clear focus.
This essentially meant a change in the Home’s environment, ie: it was filled with things for patients to do, corridors had memoirs for the patients’ lives, and generally became brighter and less clinical.
ResultsAs a result of these changes, Fairview not only used less antipsychotic medication halving the rate in 4 years, it also demonstrably improved its care rating. It initially scored a level 5 with scores comparable to below.
Positive Score Neutral Score Negative Scores30% 60% 10%
To a level 2
Positive Score Neutral Score Negative Scores60% 40% 0%
Aim
To review the training the Fairview staff undertook to bring about such a change.
Methods
The staff at Fairview initially used an observational tool, Quality of Interaction Schedule (QUIS) to record patients interactions with the staff at 5 minute intervals. The interactions were then graded into categories ranging from the most beneficial “Positive Social” to the most oppressive “Negative Restrictive”. Areas requiring improvement were highlighted, acted upon and the observing process repeated.
Below is an example of how interactions were graded into the various categories.
ConclusionsI have learnt the importance of becoming more person-centred in my approach to helping those with dementia. To this end, the GPs attending Fairview have taken on board these principles and now study behavioural charts, ask how the staff interact with patients and look to see if any reversible causes of a decline in behaviour.
ReferencesAberdeen city CHP (2009).Review of antipsychotic prescribing with care homes
for patients with dementia.Rae M. (2010). Being a star evaluation report. Dementia Matters/Barchester
Health Care.Barchester Healthcare (2012). Living disability services, the lived experience
audit. Barchester Health CareSheard D.(2010).http://www.dementiacarematters.com/pdf/OTnews2010.pdf.
Dementia Matters.
PositiveSocial
Positive Care
Neutral Negative Protective
Negative restrictive
Touching
Complement a resident
Setting right atmosphere
Sharing photos
Sharing feelings
Encourage residents to talk about their feelings.
Sing songs
Including residents in conversations
Assisting with choices-ie clothing
Joining in with resident’s hobbies
Talk to families
Giving a resident no choice in clothing.
Not informing residents in what’s about to happen
Giving out food without talking
Talking about residents not to them.
Telling someone what not to do
Limiting environment to keep it safe.
Putting patients in wheelchairs instead of waiting for them
Making a person wait for the tea trolley- they could try and make a cup of tea herself.
Feeding inappropriately- too messy.
