Northern Health
Changed Behaviour Assessment and Management
Continuing Care
Manual: Clinical Services / Procedure No:
Section: / Issue Date: October 2009
Sub-Section: / Revision No: 0
Next Revision Date: October 2013
Subject: / Page: 1 – 3
1  Purpose and Scope
This procedure relates to nursing staff who have direct contact with patients in assessing and managing the changed behaviour. There are 3 forms used to assist in identifying the triggers and interactions required to manage this behaviour and they are the “Key to Me’ , Changed Behaviour Assessment Tool, and the Personalised Care Plan
2 Policy
Refer to the name of the NH Policy with policy number.
3 Definitions
Include here all definitions of terms or abbreviations used in the procedure. It is preferable that pre-existing definitions are used.
4. Outcome
The assessment and interventions developed using this Changed Behaviour Assessment Tool (IP526) will assist in the development of strategies to manage the behaviour.
The successful interventions will be documented on the Personalised Care Plan, which will be used in conjunction with the patients care plan.
5 Procedure
·  It is recommended that the ‘Key to Me ‘document be completed by the families / carers of all patients with cognitive impairment to enable staff to better understand who the person is, what needs they might be expressing, and how staff might meet them with their care provision.
·  Nursing Staff will review this form and initiate interventions that are required. If these interventions are unsuccessful then the Changed Behaviour Assessment Tool will be commenced.
·  This tool helps clarify when the behaviour is occurring, how often, the level of changed Behaviour. It is intended for use during the INVESTIGATIVE AND REVIEW phases of the problem solving process
·  By using this tool both before and after strategies have been tried, and any changes to behaviour will be clear.
5.1. Commencement of the Changed Behaviour Assessment Tool
·  The tool is commenced when the behaviour is noticed either on admission / reason for admission or occurs during episode of care
·  The tool is continued for 4 days where practical.
·  When a changed behaviour is witnessed, please record using the time & key attached to the form
5.2. The 24hour clock is on the first page and enables the time the incidents are occurring to be monitored
·  Specific Behaviour Description assists staff in identifying the behaviour and the Key describes the impact of the change behaviour
·  From the key chose the behaviour description and number from 0-3 which indicates the level of behaviour for the incident.
·  Place it in the appropriate time box. Involve all people providing care for the person in the recording of behaviours.
·  The tool is used to identify the triggers and interventions required to assist those patients who have an identified behaviour change
Specific Behaviour Descriptions / Key for describing impact of behaviour
R = Resistive to care intervention
W A = walking aimlessly
WP = Walking with purpose
PA = Physical Aggression
VA = Verbal Aggression
A = Agitation / anxiety
H = Hallucinations – describe visual/auditory
D = Disinhibition
M = Behaviour associated with Medication administration
V = Behaviour associated with Visitor contact / 0 / Nil Distress / Person does not exhibit signs of distress
1 / Mild distress / Person exhibits anxiety expressed through changed behaviour which readily responds to current interventions
2 / Moderate
Distress / Person exhibits increasing anxiety and agitation expressed through changed behaviours. There is minimal or no response to current interventions. May respond to alternative interventions
3 / Severe Distress / Person exhibits severe distress through escalating changed behaviours which do nor respond to any interventions
5.3. Possible Factors contributing to behaviour.
Details of each episode must be recorded in order to identify the full explanation
·  Possible factors contributing to changes in behaviour - Details of each episode must be recorded in order to identify the full explanation
·  Being in hospital / away from home
·  Unfamiliar environment/disorientation
·  Personal care (hygiene)
·  Clinical interventions (eg drugs; enemas; IV’s ; dressings; injections)
·  Fear / anxiety
·  Pain
·  Physical discomfort (eg; positional; hot; cold; hungry; thirsty)
·  Elimination related (e.g. need for toilet; incontinence; retention; constipation
·  Invasion of personal space (eg; standing too close; touching)
·  Excess sensory stimulation (eg; light/ noise/ rushing)
·  Unfamiliar staff
·  Family related (wanting to see / speak to family; when family leave; when family visits; concern for family) / ·  Boredom
·  Accumulated fatigue
·  Disease process / medical process
·  Staff / patient interaction related
·  Premorbid personal interaction style (eg; usual communication style)
·  Cognition (confusion / memory / disorientation / inability to follow directions).
·  Other patients / residents
·  Restraint (being restrained)
·  Sleep disturbance
·  Disturbed social rhythm (night / day reversal)
·  Sedative drug use (causes reduction in REM sleep)
·  Response to hospital routines
·  Locked environment
·  Language
·  Other (give details)
·  Possible interventions: Choice of interventions will be dependant on individual patient and circumstances surrounding the behaviour displayed
·  Attend to basic physiological needs; discomfort; toilet; hunger; thirst; warmth
·  Comprehensive pain assessment and management
·  Minimise / prioritise nursing interventions: Prioritise and limit interventions as far as possible
·  Discontinue care activities temporarily
·  Hearing aids; may not be able to tolerate continuous use but ensure used when conversing with patient
·  Validation; listen, acknowledge and respond to what patient is saying
·  Change topic; provide alternative activity
·  One-one social interaction
·  Pacing of activities across time period; space interventions across day
·  Use of rest periods; allow patient ‘quiet’ periods / ·  Removal of restraints
·  Massage / therapeutic touch
·  Involving family : allow patient to speak to family Personal history “key to me” to assist in personalising care
·  Tape recordings of family members’ voice
·  Remove patient to quiet area
·  Use familiar staff to attend patient
·  Outdoor walks
·  Verbal orientation within patients ability
·  Verbal commands within patients ability
·  Reduce sensory stimulation; noise; light; crowds
·  Music therapy
·  Engage patient in meaningful and appropriate activities
5.4. The inside page enables documentation of the events in more detail
·  Date
·  Time
·  Where did the incident occur
·  Who was involved
·  What was happening Prior/ During
·  What was the trigger of the behaviour
·  Intervention
·  Effect of Intervention
5.5 Personalised Care Plan
As successful interventions are known these are documented on the care plan
·  Social; - Brief description of social background, which may influence or support the care plan.
·  Needs Identified; - Description of care needs based on person’s preferences, functional and health status
·  Contributing Factors (Needs); - Possible or factual reasons (e.g. pain, constipation, thirst, boredom, neurological changes, loneliness, personality) which may explain the care needs NB ‘Key to Me’ plus medical conditions/medications can provide clues to understanding factors which can influence care requirements
·  Behavioural & Psychological Symptoms; - Description of behaviours – e.g. describe the circumstances pre Behaviour e.g. where/when it may happen, relation to particular care interventions; Describe objectively the behaviours ie. What happened, staff involved etc
·  Contributing Factors; - Possible or factual reasons which may have triggered the presenting behaviours e.g. specific triggers documented from the assessment plan or from the ‘Key to Me’
·  Care interventions; - Recommended care strategies to meet the care needs and address the behaviours
5.6 Discharge Planning
·  The Personalised Care Plan is sent with the patient when either discharged home or to Residential Care to assist the carers in managing the changed behaviours with the interventions already identified.
6. Related Procedures/Instructions
Policy No. / Name
7.References
Adapted in Dec 08 from National Dementia Behaviour Advisory Service, Alzheimer’s Australia, ReBoc: a hands on guide 2004.
Behavioural Assessment Graphical Systems (BAGS) modified by La Trobe University.2006 Permission given by Queen Elizabeth Aged Care Solutions Division of Ballarat Health Services
NARI -
8 Executive Sponsor / Authors
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Title: Date:
9 Approval Authority
State the individuals or committees title and name
Title: Name: Date: