1. Reduction of Disruptive, Aggressive Behaviour
On the Older Persons Ward

2. Who is involved? Chris Cudlip – Patient Safety Lead
Karen Williams – Ward Manager
Sam Snell – Occupational Therapist
Jonathan Speed – Deputy Ward Manager
Louise Crane – Patient Safety Administrator

3. Situation
Project Initiated

4. Background Programme started September 2015
High level of Disruptive and Aggressive behaviour on the wards
Staff unable to quickly identify a person’s needs
Patients remained on enhanced observations longer than clinically required
Recording processes needed a meaningful person centred approach to reflect patients needs for a more rounded assessment on the ward

5. Benefits to the patient and staff
Patient safety
Patients experience
Staff safety
Staff experience
Better ward environment
Increased staff retention
Reducing staff sickness levels

6. Assessment
Secondary Drivers:
Aim/Primary Outcome:
Primary Drivers:
Person centred care / Cornwall Supporting Behaviour Pathway
Physical health
Medication
Communication
Patients
Reduction in Disruptive Abusive Behaviour (DAB) on Garner Ward by 40% in 12 months.
Communal areas
Noise / temperature
Doors
Number of occupied beds
Environment
Staff
Communication
Weekly Patient Safety Huddle
Training / involvement
Support / supervision
Open and just culture
Culture
Engaged and committed leadership

7. Measuring the effects of changes
Safeguard Huddles initiated
Level 2&3 Obs Chart initiated
Project Initiated

8. Measuring the effect of change
34%
reduction in DABs incidents in the first 12 months.

9. Rolling Year Data

10. Number of patients involved in the DAB incidents

11. Initiated on admission and discharge. On file with care plans.
Used from level 3 obs.

12. Care Plan

15. This is a chart that had been trialled and altered following feedback given

16. This is the reviewed and altered Level 2 and 3 Observations Chart now adopted on the ward.

17. Relative Feedback received
“I have noticed that non regular staff appear more aware of John’s* needs. One lady was able to engage in appropriate ‘banter’, but knew exactly what to do when he started to shows signs of agitation. I’m sure John* would have become aggressive if she didn’t know to stop engaging and give him space”.
AW * (patient family member)
*names have been changed.

18. Completed PDSAs Library Care Plan will incorporate traffic light care
Behavioural traffic light passports have been adopted into main practice with good results and feedback.
Some families are aware of the traffic light passport and are encouraged to contribute.
Planned weekly huddles held with Deputy Ward Manager, HCAs and Psychologist.

19. Update
Started using Level 2&3 Obs Chart beginning Dec Which incorporated a sleep chart therefore reducing the number of forms needed to complete per patient.
Safeguard Huddles initiated every Tuesday morning (protected time) since November 2016.
Discuss incidents raised over past 7 days
Review and update care plans and risk assessments to reflect identified reports raised within the past 7 days
Review observations charts for patients on level 2 and 3 with the view of checking and subsequently decreasing the level of observation for patients not presenting at triggering or escalation phase behaviour
Linking with incidents reflecting the observation charts and discuss amongst wider team to encourage open and just culture

20. Next Steps
Further development of traffic light passport for nutrition, moving and handling and personal care. Good feedback received from HCAs.
Electronic application funding is being sought by Medical Director so that the data can be analysed from ten minute observations.
Embed Safety Huddles into weekly practice

21. Recommendations
Keep talking to staff about what we are trying to achieve
Continue to foster family involvement and awareness of the Patient’s Traffic Light Passports.
Continue to keep all members of the ward team actively involved in all processes and decisions.
Allocate protected time to keep moving forward
Report back to safety champions

22. Barriers Positive Outcomes Time alongside frontline role
Staffing levels within the ward
Positive Outcomes
Increased awareness and compliance of reviewing and utilising the traffic light system
Eradicated needless duplication of paperwork
Meaningful Person Centre Approach

23. Key improvement message
“Everyone has a part to play in the planning and implementation of the project.”