TitleStudent’s Name, Faculty

Name of Affiliated Department, Division, or Theme1 ; Department Name2,

University of Alabama at Birmingham

GoalCreating Culture Change.

The biggest goal of the program is creating a culture change

within the facility. It is critical that all facility staff move toward

having a patient-centered point of view when making

decisions about how to handle behaviors and depression

symptoms.

For example, some residents are at risk of falling and they

continuously try to get up and walk. Instead of giving the

resident a pill for “anxiety” or “behavior,” staff should problem

solve and ask the question, what do the behaviors mean? Is

the resident hungry? Tired? Has to use the restroom?

Bored? Behaviors almost always are some form of

communication from the resident.

Conclusion You can plan too much. Sometimes it is best to just start

the project and continuously improve along the way.

Waiting until the plan is “perfect” is unrealistic.

Culture change happens very slowly. Change is always

hard, but when staff can see the benefit and reason behind

the change, change will happen.

Acknowledgements: Executive Director Chad Ketcham, Director of Nursing Rhonda Lewis, Social Worker/Project Manager Joan Gonzalez, UW – Eau Claire Printing Services

Timeline1. Purchase Non-Pharm Interventions

Blanket Warmers, Essential Oils, Busy Kits,

____Therapy (Animal, Music and Art), Games, etc.

2. Education for Floor Staff, Department Managers,

Doctors, Nurse Practitioners, and Pharmacy Consultant.

3. Create progress logs on what interventions are being used

on who. What works? What doesn’t?

4. Continue to use feedback to improve program

PDSA Cycle

RecommendationsIf I could redo this program, I would initially involve more staff

members, such as CNAs and Nurses who would be utilizing

this program the most. Input from floor staff is critical and

valuable to the success of any program. I think this would

also help with employee engagement. If employees have a

voice, they are more likely to participate and support the

program.

BackgroundGolden LivingCenter-Greeley has had a recent increase in

antipsychotic use, depression symptoms and behaviors

occurring in the third Quarter of 2015. The facility received a

grant funded by the state aimed at reducing antipsychotic

medications, depression and behaviors. This program is a

Nursing Facility Performance – Based Incentive Payment

Program, but I will refer to as “Healthy and Happy Living

Program.”

8.3 8.2

6.7

2.5

3.6 3.5 3.6 3.6

NOV-15 DEC-15 JAN-16 FEB-16

% o

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GLC - Greeley Depression (LS)232% Reduction

GLC - Greeley PR National Benchmark

15.216.7

13.6

7.7

17.6 17.8 17.5 17.3

NOV-15 DEC-15 JAN-16 FEB-16

% o

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eh

avio

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GLC - GREELEY BEHAVIOR (LS)117% Reduction

GLC - Greeley PR National Benchmark

Healthy and Happy Living ProgramReducing Antipsychotic Medications, Depression & Behaviors

Leah Ripp Golden LivingCenter - Greeley

23.721.8 21.9

20.6

17.8 17.4 17.2 17

NOV-15 DEC-15 JAN-16 FEB-16% o

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An

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GLC - Greeley Antipsychotic (LT & SS)15% Reduction

GLC - Greely PR National Benchmark

Good

IntroductionA large number of the individuals in skilled nursing centers are living with some type of dementia. For these individuals and as illness progresses, behavior often becomes a key form of

communication. This can be challenging to families and staff, and too often, antipsychotic medication is used in an attempt to modify behavior.

Good

Good

Results Continued Depression.

Depression has decreased in our Long Term Care residents

by 232%! This has been the biggest indicator of success, as

staff can tell residents are generally more happy as they have

more activities to indulge in. Using a resident-centered point

of view allows each resident to participate in activities and

therapies that are of interest to them and their care needs.

Behavior.

Behaviors have also decreased by 117%. As depression and

antipsychotic medications decreased, behaviors started to

decline as well. When residents become happier with their

care and life at GLC-Greeley, we see less behaviors.

Furthermore, eliminating antipsychotic medication for some

residents has created more alertness and decreased

behaviors. Overall, I am very pleased with the results knowing

there is still room for improvement.

Essential oils have been a key

element of success for the

Happy and Healthy Program.

Lemon scents are used in

morning activities to promote

alertness and participation.

On the other hand, when

residents have insomnia or

anxiety, utilizing lavender

spray on resident pillows or

drinking Chamomile Tea

promotes relaxation and

sleep. Essential oils can be a

great option for almost any

behavior!

Utilizing different therapies

has decreased use of

antipsychotic medications,

depression and behaviors.

As seen in the picture

above, this bunny gave our

resident's a big smile on

Easter Sunday.

ResultsAlthough we are only 6 months through a 2 year program, we

have already seen amazing results

Antipsychotic Medications.

GLC – Greeley had an initial percentage of residents on

Antipsychotic Medications of 23.7%, compared to the national

benchmark of 17.8%. The Heathy and Happy Living Program

has dropped this antipsychotic use by 15% through the use of

non-pharm interventions, education and engaging our staff.

(Seen on graph to the left).

Examples