The Evidence Integration Triangle for Management of Behavioral Psychological Symptoms of Dementia

Abstract

Problem and Purpose Behavioral Psychological Symptoms of Dementia (BPSD) are described as symptoms of apathy, agitation, inappropriate vocalization, aggression, wandering, and resistance to care. Incorrectly managing BPSD can lead to the improper administration of psychotropic medications, which can negatively impact the health and quality of life for residents with dementia. The purpose of this quality improvement project was to implement the Evidence Integration Triangle for Management of Behavioral Psychological Symptoms of Dementia (EIT-4-BPSD) in a nursing home. The Evidence Integration Triangle is a four-step implementation framework that includes participatory implementation processes, provision of practical, evidence-based interventions, and pragmatic measures of progress towards goals. Methods The EIT-4-BPSD was implemented over a ten-week period. The four steps included: Step 1: Assessment of the environment and policies; Step 2: Education of staff; Step 3: Establishing person-centered care plans; and Step 4: Mentoring and motivating staff. Outcomes were evaluated pre and post-implementation. Resident outcomes were obtained from the Minimum Data Set National Database and included: use of psychotropic medications and falls. Staff outcomes included knowledge of person-centered behavioral approaches for BPSD based on a 10-item multiple-choice test. Facility outcomes included evaluation of a random sample of five de-identified care plans to evaluate for evidence of incorporation of person-centered approaches to managing BPSD. Results Patient outcomes revealed a 12.5% decrease in the administration of psychotropic medications and a 5.6% decrease in falls. Nurse’s post-test knowledge of person-centered management of BPSD increased from 63.5% to 70% post-implementation. Evidence of established personcentered care plans increased from 40% at baseline to 90% post-implementation. Conclusion The EIT-4-BPSD intervention was practical to implement and provided the staff with information and resources to help integrate person-centered behavioral approaches into care plans and routine clinical care. Ongoing work by the nurse champion is needed to continue to maintain the focus on the use of person-centered behavioral approaches.