Nonpharmacological Interventions for Behavior Management in Dementia

Abstract

Since 2011, the Centers for Medicare and Medicaid (CMS) have been monitoring antipsychotic usage in residents with dementia in nursing homes. Increased monitoring has led to a decrease in use of these medications in long-term care settings. At the project site, a skilled nursing facility in Western North Carolina, residents with dementia are ordered to have all antipsychotic medications discontinued on admission. Unfortunately, medications typically are not useful in treating disruptive behaviors in residents with dementia. Nonpharmacological interventions (NPIs) are considered best practice; however, when nonpharmacological interventions are appropriately utilized at the facility, there was no standard for documenting their usage. A newly created standardized nonpharmacological checklist was implemented in order to guide staff members in utilizing nonpharmacological interventions prior to the administration of PRN (as needed) behavior medications. The primary objective of the project was to increase compliance with the implementation of nonpharmacological interventions in the management of disruptive behaviors in residents with dementia. The project implementation resulted in a 70% staff compliance rate in utilizing the standardized checklist. Staff reported a much better understanding of how to utilize NPIs in their interactions with residents with dementia. While the outcome of the project was positive, many barriers and limitations were encountered throughout the process.