* Your team leader can provide assistance with accessing these resources
Supporting safe and high-quality person-centred care is essential. This information is useful for hospital and residential aged care facilities.
Important information for keeping people S A F E
Potential situation factors that can trigger behaviours are:
Being in isolation also increases the risk of adverse events (agitation, falls).
When isolating individuals with suspected or confirmed COVID-19, take the following steps.
COVID-19 will force changes to the clinical environment, these may include:
Consider requirements for closer engagement and observation in the COVID-19 context, such as skilled staff, short shifts, nurse tag in-tag out.
Consider infection control requirements, including PPE needs and individualised room set-up. Inform and discuss these changes with the individual, their family and carers.
Identify your resource person and speak with them if you need advice on how to access any of these suggested resources.
Used to engage the person in purposeful activity (magazines, puzzles, fidget boards, towel folding, toolbox). Some activities require no planning and others need a little preparation. Have some prepared options accessible to use if needed. Consider individual boxes that will be discarded.
Unfamiliar environments, people, noise and routines can cause anxiety for people. Provide reassurance and support frequently. Address underlying feelings if possible. Engage in activities. Avoid caffeinated drinks.
Use open body language with your interactions with the person. Approach from the front with a wave and smile (consider use of full-face shield where available, without mask). If the person is sitting or in bed do not stand over the person, meet at eye level. Consider posture, position and respect personal space. Hands open and visible.
Patients who present with confusion can sometimes behave in ways that places themselves or others at risk. Close observation or ‘specialling’ of these patients may be considered. Refer to local guidance.
Stimulation can reduce wandering behaviours and enable trust. Engagement involves supporting nutrition, personal care, mobility and daily living. Conversations can be about their interests, preferences, likes and dislikes, personal history and so on.
Establish with the family and carers who is nominated as the ‘person responsible’ and who is the ‘key contact person’ to receive information and updates. Where these are different people the care team must have a written communication plan.
Provide support in establishing virtual interactions for the family and carers. Schedule times for virtual visits. Before the scheduled time, arrange to have a device ready, link to facility wi-fi, and have support to help the person use and understand the technology. Make it a positive experience.
Encourage the family and carers to use the REACH program if required.
Use culturally specific communication cards to prompt discussion, assist with directions and clarify needs.
Intentional rounding is a structured approach whereby nurses conduct checks on patients at set times to assess and manage their fundamental care needs.
Encourage and assist with eating and drinking. Eating all meals out of bed engages the person in usual tasks. Establish food likes and dislikes with the person and their family and ensure these are documented. Consider access to snacks and drinks on the ward for when the person is seeking food or drink. Finger foods may be well accepted.
Consider equipment, devices and tools to promote safe mobility and reduce harm from falls. There are bed and chair alarm devices that may be considered which will indicate when a patient is moving or standing. Sensor alarms need to be carefully considered if they are appropriate for the wandering patient. Some alarms may increase agitation and will not be useful or appropriate for many wandering patients.
Contact your local falls coordinator for information. Follow local infection control procedures.
Being active can reduce wandering behaviours. Encourage activities like participating in showering and other grooming and self-care activities, getting out of bed and moving around the ward with supervision or assistance if required, and participation in exercises. Consult with your allied health teams. Clinical Excellence Commission - Safe mobilisation,
Individualised music therapy can be used to engage, calm or reassure the person with something familiar. Discuss music options with the person, their family and carers. Use available technology to assist, e.g. the patient’s own devices, such as tablets, phones.
Monitor agitation and distress as a signal of pain. Assess for acute and chronic pain using non-verbal pain tools (e.g. Abbey Pain Scale, PAINAD). Monitor with regular rounding and treat pain. Implement non-pharmacological approaches along with pharmacological interventions. Provide regular analgesia as opposed to as needed.
TOP 5 - is a communication tool that encourages health professionals to engage with carers to gain valuable non-clinical information to help personalise care.
This is Me - this tool, developed by Alzheimer’s Society UK, is used to identify the needs, interests, preferences, likes and dislikes of people with dementia.
Sunflower - Use this tool to find out more about the older person including their interests and hobbies. The Sunflower is part of the ACI CHOPs program.
Safety huddles are a brief, focused exchange of information about potential or existing safety risks, e.g. falls, delirium, nutrition, pressure injury, which may affect the person, staff and any person accessing the healthcare environment. Safety huddles, Clinical Excellence Commission.
Use signs to assist with wayfinding. For example, label the toilet door with a picture of a toilet and the word ‘toilet’. Include in the room items that help with orientation such as clocks, a calendar, familiar items, such as photos of family, etc. Display calming images or artwork, e.g. landscape prints, displays on TV, disposable art.
Discuss impact of infection control processes with family and carers.
Noise causes sleep disruptions but when reduced can lead to more sleep and less intrusive behaviours. Review the sound and light environment. Try calming music in the evening, exposure to natural light during the day and dim lighting during the night. Maintain usual sleep routines and usual sleep attire. Encourage participation in daytime activities and minimise daytime sleeping.
People often wander when they are seeking the bathroom. Conduct rounding to encourage a regular toileting routine. Encourage walking to the toilet, with supervision or assistance if required.
The development of this document has evolved from existing Australian and international resources with an expert advisory group encompassing aged health, dementia, delirium, falls, older people’s mental health, and mental health medical, nursing and allied health experts. This included members from the local health districts, Agency for Clinical Innovation, Clinical Excellence Commission, Health Education Training Institute and Ministry of Health.
Additional acknowledgements: South Eastern Sydney Local Health District and Mid North Coast Local Health District.
Expert Advisory Group
Aged Care/Aged Health COP Members
Dr Nigel Lyons, Deputy Secretary, Health System Strategy and Planning
Clinicians and staff working in health care and residential aged care facilities
Feedback on this document can be provided to MOH-Covid-19AgedCareCOP@health.nsw.gov.au