1. Title
Student’s Name, Faculty
Name of Affiliated Department, Division, or Theme1 ; Department Name2,
University of Alabama at Birmingham
Goal
Creating 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
Timeline
1. 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
Recommendations
If 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.
Background
Golden 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
%ofResidentsWithDepression
GLC - Greeley Depression (LS)
232% Reduction
GLC - Greeley PR National Benchmark
15.2
16.7
13.6
7.7
17.6 17.8 17.5 17.3
NOV-15 DEC-15 JAN-16 FEB-16
%ofResidentswithBehaviors
GLC - GREELEY BEHAVIOR (LS)
117% Reduction
GLC - Greeley PR National Benchmark
Healthy and Happy Living Program
Reducing Antipsychotic Medications, Depression & Behaviors
Leah Ripp Golden LivingCenter - Greeley
23.7
21.8 21.9
20.6
17.8 17.4 17.2 17
NOV-15 DEC-15 JAN-16 FEB-16
%ofResidentsonAntipsychotics
GLC - Greeley Antipsychotic (LT & SS)
15% Reduction
GLC - Greely PR National Benchmark
Good
Introduction
A 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.
Results
Although 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