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British Columbia Update: Geriatrics Psychiatry - Dr. Carol Ward

03 Nov 2014 10:15 AM | CAGP (Administrator)

The 2015 BC Psychogeriatric Annual Meeting will be held in Kamloops, BC, April 24-25. The conference title is “Maintaining the Momentum: Sustaining Initiatives in Older Adult Mental Health”. This is also an appropriate theme for this update as my colleagues and I reflect on new developments within the Division of Geriatric Psychiatry at UBC and initiatives at the health authority and provincial level.

Our last update ended with a big thank you to Dr. Martha Donnelly for her leadership in this field both academically, provincially and nationally. Martha stepped down from the role of Head of the Division of Geriatric Psychiatry at UBC. Dr. Michael Wilkins-Ho has taken over and the transition has been seamless. The Division continues to link with sites around the province via monthly Geriatric Psychiatry Videoconference Rounds. This September brings CADRE rounds (Current Areas of Division Research Endeavours), which will use this videoconference network to showcase the academic and research projects by the subspecialty residents and division members

The Subspecialty Resident Training Program in Geriatric Psychiatry is in its third year and currently has four residents. It completed its internal review this year with favourable results, although secured position funding remains a challenge.

The University of British Columbia, Department of Psychiatry has created the position of Oversight Director to develop the geriatric psychiatry rotation experience for resident training across distributed sites in the province.

Many exciting initiatives that directly impact on the care of older adults with mental health problems and illnesses are occurring in the province. The BC Dementia Action Plan is being updated this fall. It will provide a strategic framework for dementia care over the next three years.

Development of an educated dementia care work force is a major priority for all of us who practise in the field of older adult mental health. P.I.E.C.E.S. a Model for Collaborative Care and Changing Practice is a learning and development program for professionals who provide care for individuals with complex cognitive and mental health needs. The Kamloops Integrated P.I.E.C.E.S. Initiative and Residential Care in the province continue to bring this training to registered staff. This year the UBC Tertiary Geriatric Psychiatry Committee is hosting a P.I.E.C.E.S. Facilitator development workshop, which will allow us to implement it in our tertiary mental health sites. The goal is to develop a cadre of facilitators who can then collaborate in leading the 24 hour P.I.E.C.E.S. program in each of the five health authorities. The expansion of the program will bring a common vision, language and approach. This will surely help those persons with the lived experience of mental health problems and illnesses as they transition between the different parts of the continuum of care.

Gentle Persuasive Approach (GPA) is a practical dementia education program that targets all staff including health care aides on how to respond respectfully and with confidence to those who present with dementia responsive behaviours. This program is gaining traction in our residential and tertiary mental health sites.

The BC Patient Safety and Quality Council (BCPSQC) launched their CLeAR (Call for Less Antipsychotics in Residential Care) initiative early this year. The goal is to reduce the overall prescription use of antipsychotics in people with dementia related responsive behaviours and ensure that they are used appropriately. The BCPSQC is supporting more than 50 residential care facilities in the development of individual quality improvement projects with this goal in mind. This initiative has created great excitement as it promotes a consistent approach to assessment, education and psychosocial interventions. P.I.E.C.E.S. and GPA are recognized as important initiatives in achieving this culture change.

Following the development of the BC Best Practice Guideline for Accommodating and Managing BPSD in residential care in 2013, the Ministry of Health co-ordinated an inter-professional collaborative of more than 30 health care professionals to expand and refine the Interior Health Authority BPSD algorithm. A consensual decision-making process was developed and guided by Elisabeth Antifeau (Chair). The updated algorithm is a comprehensive, one-stop resource for a person-centred care approach to BPSD. The BCPSQC moved the algorithm from paper to a web/smart device friendly tool and actively promotes its use as part of the CLeAR initiative.

The purpose of its development is to provide nurses, family practitioners and allied health professionals involved with the care of those suffering from dementia related responsive behaviours with best practice recommendations for assessment, evidence-based assessment tools and support material. It is also a good teaching tool for medical students and residents. It has two main parts: Part 1 – Interdisciplinary Decisional and Practice Support for BPSD (Assessment, Problem Solving, Care Planning) and Part 2 – Reassessment with Family Physician or Nurse Practitioner for BPSD (Re-assessment, Medication Options, Monitoring). Feedback on its design and utility is welcome and can be given on the web-site shown below.

Check out www.bcbpsd.ca!  

Carol Ward, MD

CAGP Board Member representing BC


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