frank sinatra playing distraction tools - nsw … · playing his favourite music by frank sinatra....

1
D INDIVIDUALISED DISTRACTION METHODS The Care Cue Flower, sourced from the Agency for Clinical Innovation, was introduced at the beside to individualise a non-pharmacological approach to managing confused patients. Review of these flowers indicated there was a need for the introduction of a Distraction Tools Box. Frank Sinatra playing Hat from the Distraction Tools Box 9.64 0 11.19 14.44 14.79 4.76 0 4 8.06 3 April May June July August 2015 2016 10.01 3.96 Pre-implementation Post-implementation FALLS PER 1000 BED DAYS MEAN FALLS PER 1000 BED DAYS 2.8 1.8 Preimplementation Postimplelemtation ART CALLS PER MONTH SUCCESSFUL DISTRACTION According to his Care Cue Flower, the confused patient (below) had a history of wearing a hat daily and loved to listen to the music of his era. Using this information, his confusion was successfully managed using non- pharmacological strategies. Contentment was maintained by providing a hat from the Distraction Tools Box and playing his favourite music by Frank Sinatra. Having these recourses readily available enabled the staff on Med 1 to create a safer environment for this patient and reduce their workload commonly associated with a wandering patient. DISTRACTION TOOLS Using the data from the Care Cue Flowers over time, along with staff and carer consultation, Distraction Tool Boxes were developed to reflect values, beliefs, interests and work history of the patient. The Med 1 team engaged in the design, creation and implementation of the boxes consisting of two male, two female and one unisex box. Considering all stakeholders, this process involved the collaboration with services such as infection control, dementia and delirium specialists, medication prescribers and community carer liaisons. BACKGROUND When Manly Hospital restructured in 2015, the Orthopaedic Ward became the Acute Medical Ward 1 (Med 1). With this came a rise in the number of confused patients presenting with delirium and dementia. These patients were at risk of harm to themselves and others through falls, aggression and treatment interruption. Falls increased from 4.8 to 10 per 1000 bed days, and the number of Aggression Response Team (ART) calls rose from a monthly average of zero to 2.8. In response to these changes, an initiative using a non- pharmacological approach to managing the confused patient was commenced. OUTCOME The introduction of the distraction tools led to a decrease in patient anxiety and an increase in contentment. Patients were observed to remain calmer and willing to remain seated, engaging in the distraction. This resulted in the reduction of episodes of aggression related to confusion, pharmacological restraint and falls. The development of this new practice emerged through continuous collaborative reflection and action planning. Ongoing evaluation of these strategies occurs through consultation with nurses and carers. Nurses and carers now report to be more equipped with the knowledge and resources to non-pharmacologically manage the confused patient.

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Page 1: Frank Sinatra playing DISTRACTION TOOLS - NSW … · playing his favourite music by Frank Sinatra. Having these recourses readily available enabled the staff on Med 1 to

D INDIVIDUALISED DISTRACTION METHODS

The Care Cue Flower, sourced

from the Agency for Clinical

Innovation, was introduced at

the beside to individualise

a non-pharmacological

approach to managing

confused patients. Review

of these flowers indicated

there was a need for the

introduction of a Distraction

Tools Box.

Frank Sinatra playing

Hat from the Distraction Tools Box

9.64

0

11.19

14.44 14.79

4.76

0

4

8.06

3

April May June July August

20152016

10.01

3.96

Pre-implementation Post-implementation

FALLS PER 1000 BED DAYS

MEAN FALLS PER 1000 BED DAYS

2.8

1.8

Preimplementation Postimplelemtation

ART CALLS PER MONTH

SUCCESSFUL DISTRACTION

According to his Care Cue Flower, the confused patient

(below) had a history of wearing a hat daily and loved to

listen to the music of his era. Using this information, his

confusion was successfully managed using non-

pharmacological strategies. Contentment was maintained

by providing a hat from the Distraction Tools Box and

playing his favourite music by Frank Sinatra. Having these

recourses readily available enabled the staff on Med 1 to

create a safer environment for this patient and reduce their

workload commonly associated with a wandering patient.

DISTRACTION TOOLS

Using the data from the Care Cue Flowers over time, along

with staff and carer consultation, Distraction Tool Boxes

were developed to reflect values, beliefs, interests and work

history of the patient. The Med 1 team engaged in the

design, creation and implementation of the boxes

consisting of two male, two female and one unisex box.

Considering all stakeholders, this process involved the

collaboration with services such as infection control,

dementia and delirium specialists, medication prescribers

and community carer liaisons.

BACKGROUND

When Manly Hospital restructured in 2015, the Orthopaedic

Ward became the Acute Medical Ward 1 (Med 1). With this

came a rise in the number of confused patients presenting

with delirium and dementia. These patients were at risk of

harm to themselves and others through falls, aggression and

treatment interruption. Falls increased from 4.8 to 10 per

1000 bed days, and the number of Aggression Response

Team (ART) calls rose from a monthly average of zero to 2.8.

In response to these changes, an initiative using a non-

pharmacological approach to managing the confused

patient was commenced.

OUTCOME

The introduction of the distraction tools led to a decrease in

patient anxiety and an increase in contentment. Patients were

observed to remain calmer and willing to remain seated,

engaging in the distraction. This resulted in the reduction of

episodes of aggression related to confusion, pharmacological

restraint and falls. The development of this new practice

emerged through continuous collaborative reflection and action

planning. Ongoing evaluation of these strategies occurs through

consultation with nurses and carers. Nurses and carers now

report to be more equipped with the knowledge and resources

to non-pharmacologically manage the confused patient.