Between July 2016 – March 2017, the North Simcoe Muskoka Specialized Geriatric

Services (SGS) Program collaborated with partner NSM hospitals to implement the

time-limited Behaviour Success Agent (BSA) project. Using funding provided by the

NSM LHIN, a 0.5 FTE BSA was placed in each NSM hospital site. The purpose of this

project, which stemmed from the findings of the November 2015 Behaviour

Concurrent Review, was to:

Improve the quality of care provided to hospitalized older adults with

cognitive impairment and responsive behaviours;

Build the knowledge capacity of health care professionals;

Improve hospital flow and reduce ALC days; and,

Enhance partnerships and service delivery knowledge between service

providers

Building capacity in each NSM hospital through the education and

mentorship of individual BSAs (including PIECES training, GPA training, etc.);

Development of individualized responsive behavior care plans for hospitalized

seniors; and,

Development and implementation of numerous standardized resources

across NSM hospital sites:

A Best Practice Guideline for Individuals with Cognitive Impairment and

Responsive Behaviours in Acute Care;

Standardized Responsive Behaviour Definitions

Standardized Behaviour Clinical Documentation

A Patient & Family Brochure

Standardized Education Modules

PATIENT OUTCOMES

1. The BSA project exceeded all funding targets set by the LHIN.

2. There was a 68% reduction in the frequency of the identified primary responsive

behaviour in patients seen by the BSA.

3. There was a 74% reduction in the frequency of use of physical restraints during the

BSA intervention period.

4. There was a 68% reduction in the frequency of PRN medication administration

during the BSA intervention period.

5. Of the individuals served, 12% were found to show symptoms of an undiagnosed

delirium by the BSAs. * According to the PIECESTM Resource Guide 2010, hospitalized patients have a 33% mortality rate.

Target Totals

# individuals served 125 166

# of Visits 750 1712

# of Education Occurrences 1800 2213

SUSTAINABILITY

Behaviour Success Agent (BSA) Project

Waypoint Centre for Mental Health Care (Lead Agency)

Collingwood General and Marine Hospital

Georgian Bay General Hospital

Muskoka Algonquin Health Care

Orillia Soldiers’ Memorial Hospital

Royal Victoria Regional Health Centre

PROJECT OVERVIEW

“I feel we have accomplished more than simply completing tasks and meeting deadlines. As a team, we have delivered sustainable, cohesive, patient-centered care.

More important, we have emerged as a working example to all healthcare providers within our LHIN of what can be accomplished when organizations work together.”

Behaviour Success Agent , March 2017

As a requirement of funding, each hospital was required to develop a sustainability

plan. One-day snapshots were completed at the end of the project and at 3 and 6

month post-project intervals as an indicator of sustainability. The focus was on

patients designated ALC in acute and post-acute hospital settings with behaviours

that impact care and/or transition (i.e. delay or have the potential to delay

discharge; impact the ability of staff to deliver usual care). Although it is recognized

that many variables could have impacted outcomes, findings 6 months post-

project showed:

All participating organizations recognized the value in the role of the BSA

with some retaining the role, or a form of the role.

All participating organizations adopted the best practice guidelines and

standardized documentation tools.

100% of patients had a documented clinical assessment.

90% of patients had an individualized behaviour care plan.

A continuous decline in the number of patients waiting LTCH placement.

A decrease in the total number of ALC days compared to the initial 2015

Behaviour Concurrent Review.

AUTHORS:

Annalee King, Behaviour Support System Manager, NSM SGS Program

Tamara Nowak-Lennard, Clinical Manager/ Regional Clinical Nurse Specialist, NSM SGS Program

NSM Behaviour Service Implementation Steering Committee

PROJECT OUTCOMES

For more information about the BSA project or the NSM SGS Program:

www.nsmsgs.ca

“… the greatest successes I

have experienced during this

project have come from the

patients themselves. The suc-

cess of this project can and

should be measured in direct

correlation to the improvements

and accomplishments made in

patient care.”

“Having a contact person within each hospital has been beneficial from a system perspective. We have discussed and shared our organizations policies, procedures, and

processes in an informal way. This has been incredibly beneficial as it encourages discussion, provides guidance and also allows each of us to adapt processes other

organizations already have in place to fit with our own organizations goals. This then reduces overall workload and creates commonality across the hospitals within our LHIN.”

Behaviour Success Agent, March 2017

PARTICIPATING ORGANIZATIONS