NARI is working with Victorian hospitals and the Victorian Department of Health (DH) to develop best practice principles for the management of patients with severe behavioural and psychological symptoms of dementia (BPSD).

Hospitals and BPSD

Hospitals are known to be challenging places for people with dementia and, in particular, those presenting with BPSD. There are numerous physiological and psychosocial factors associated with being acutely unwell that can make symptoms worse, especially in an unfamiliar and often unsuitable physical and social environment.

These new or changing symptoms can be difficult to manage, can cause significant distress to family members, staff and other patients and can result in increased morbidity and mortality.

Current Models of Care in Victoria

A preliminary benchmarking survey of 9 metropolitan and 3 regional health services in Victoria was conducted by the Sub-Acute Executive Peak Body in 2019. The survey revealed that, while 100% of health services provide care for patients with dementia and BPSD in sub-acute settings, the individual models of care developed to support this patient population varied significantly¹.

The survey also showed that there are a number of challenges in achieving a responsive specialist service for patients with dementia and BPSD. These include:

• workforce recruitment
• retention
• level of skill and overall safety
• access to specialist mental health services
• issues relating to the environment.

Developing Recommendations for Future Service Delivery

In order to develop best practice principles for the management of patients with severe BPSD in hospital we will:

1. Conduct a rapid literature review of international and national best practice principles and models of care.
2. Analyse incidents, adverse events and outcomes relating to the management of patients with severe BPSD in Victorian hospitals.
3. Conduct a desktop review of models of care for inpatients who have significant behavioural and psychological issues, without an underlying diagnosis of dementia, in select Victorian hospitals.
4. Undertake a gap analysis of current hospital management of patients with severe BPSD against identified best practice across Victoria.
5. Interview family members and staff about their experiences of the hospital management of patients with severe BPSD in Victoria.

References

Munro D. Caring for People with Dementia in Victorian Hospital Benchmarking Data Report. 2020