Organizational/Institutional Needs Assessment Order Number 1. Do you routinely screen for behavioural symptoms of dementia or responsive behaviours? * Yes No Not Sure 2. What behavioural screening do you do? * Admission History Specific Questions to Screen for Aggression, Resistance to Care, Wandering Cognitive/Dementia Screening such as MMSE or MOCA Standardized Behaviour Inventory such as NPI, Cohen-Mansfield Inventory Caregiver Interview Review of Hospital Discharge Summary Other If other, please specify 3. How frequently do you do behavioural screening? * On Admission Daily q RN Shift Weekly Quarterly 4. What behavioural supports are available to help support your care currently? * Advanced Practice Clinician On-Site Dedicated to Behavioural Support Advanced Practice Clinician Available by Phone to Support Behavioural Care Security Personnel Code White Response Calling 911/Police/Crisis Line Specialized Outreach Team Available Psychiatrist Other If other please specify 5. Please describe the availability of * Available immediately Available within an hour Available within the day Available within the week Available within the month Longer than a month to get support Please describe the availability of * Available immediately Available within an hour Available within the day Available within the week Available within the month Longer than a month to get support Please describe the availability of * Available immediately Available within an hour Available within the day Available within the week Available within the month Longer than a month to get support Please describe the availability of * Available immediately Available within an hour Available within the day Available within the week Available within the month Longer than a month to get support Please describe the availability of * Available immediately Available within an hour Available within the day Available within the week Available within the month Longer than a month to get support 6. Please list the three biggest challenges in supporting the care of behaviourally symptomatic patients in your facility * Second Biggest Challenge Third Biggest Challenge 7. Please indicate what, if any, standardized approaches you currently have available for these behavioural symptoms Wandering/ Exit-Seeking * Standardized Care Plans Patient-Specific Care Plans Environmental Strategies Medication Strategies Communications/ Shift-Handoff Strategies Visual Management Strategies (i.e. special ID bands or name tags to alert ot the safety risk) Resistance to Care * Standardized Care Plans Patient-Specific Care Plans Environmental Strategies Medication Strategies Communications/ Shift-Handoff Strategies Visual Management Strategies (i.e. special ID bands or name tags to alert ot the safety risk) Aggression * Standardized Care Plans Patient-Specific Care Plans Environmental Strategies Medication Strategies Communications/ Shift-Handoff Strategies Visual Management Strategies (i.e. special ID bands or name tags to alert ot the safety risk) Apathy * Standardized Care Plans Patient-Specific Care Plans Environmental Strategies Medication Strategies Communications/ Shift-Handoff Strategies Visual Management Strategies (i.e. special ID bands or name tags to alert ot the safety risk) Other * Standardized Care Plans Patient-Specific Care Plans Environmental Strategies Medication Strategies Communications/ Shift-Handoff Strategies Visual Management Strategies (i.e. special ID bands or name tags to alert ot the safety risk) If other please specify 8. Information is collected on the following: Critical Incidents * Yes No I am not sure Staff Injury from Patient Behaviour Incidents * Yes No I am not sure Referrals to Behavioural Resources * Yes No I am not sure Staff Training in Behavioural Management ( e.g. GPA, Montessori) * Yes No I am not sure Other * Yes No I am not sure If other please specify 9. What do you think is the biggest barrier to safer behavioural care in your facility? * 10. Do you have any of the following supports in your institution currently? Check all that are present * Wanderguard System Bed Alarms Electronic Medical Record Restraint Policy Secure/Locked Unit Cameras Snoozelen Room Psychogeriatric Outreach Team Special Dementia Floor Special Clothing/Identification for At Risk Patients/Residents Urgently Available Constant Care or PSW Support Behavioural Supports Ontario Support Psychogeriatric Resource Consultant Compassion Fatigue Training or Resilience Training for Staff Music Therapy Pet Therapy Other If other please specify 11. How would you describe the current culture of dementia care at your facility? * It is an institution-wide priority Not a focal priority We had a few lectures but nothing systematic in place It feels like everybody here has dementia Nobody seems to care that these patients are really hard to help There is top-down appreciation that these are challenging patients 12. Please check all of the following that you COLLECT at your institution? * GIAP scores Staff satisfaction Patient satisfaction Family satisfaction Staff turnover Critical incidents/WSIB claims 13. Please indicate training utilized to support patients with cognitive or behavioural disorders at your institution. * Gentle Persuasion Approach (GPA) Montessori Method PIECES REITMAN CAREERS Training ABC Charting DOS Charting PMAB (Prevention and Management of Aggressive Behaviour) NVCI (Non-VIolent Crisis Intervention) If other please specify 14. Your contact Name * Company * Address * City/town * State/Province * ZIP/Postal Code * Country * Email Address * Phone Number *
