Non-Pharmacological Approach to Disruptive Behaviors Due to Cognitive Impairments

Background: CMS has challenged long term care facilities to decrease the use of antipsychotics to manage dementia in the geriatric population.  In Massachusetts an approach called OASIS was instituted in 10 pilot facilities.  The Boston Home successfully applied to be the 11th facility in this pilot and to try the OASIS approach with a younger population of individuals with cognitive impairments secondary to MS who exhibited disruptive behaviors and/or behaviors that were difficult for caregivers to manage.

Objectives: 1. To reduce the number of patients without psychiatric diagnoses that are receiving antipsychotics for disruptive or difficult behaviors.  2.  To incorporate behavior managment techniques into the role of all caregivers as a core competency.  3.  To reduce the number of patient and/or caregiver concerns to management about difficult interactions between patient and caregiver.

Methods:  1. Train all staff in OASIS principles and STAR responses modified to address the needs of this population.  2. Establish an OASIS interdisciplinary team to review individual cases, guide care plan changes, and mentor staff.  3. Develop performance standards that reflect core competency in OASIS principles  4. Create opportunities to celebrate positive OASIS experiences.

Results: 1. 28% decrease in use of antipsychotics overall and 100% decrease in antipsychotics for individuals without psychiatric diagnoses.  2. 85% of all staff (including non clinical staff) completed 8 hours of training in OASIS principles and STAR responses.   3.  An increase in the use of mediation with patients and care givers and staff education and a decrease in disciplinary action as solutions to patient complaints about interactions with staff.  4. Modified OASIS standards are now a standard component of the employee orientation, continuing education and performance evaluation process.

Conclusions: Adults with cognitive impairments due to MS respond positively to the OASIS model of behavior management and require less antipsychotic medication when these techniques are used by caregivers. Mediation and education successfully resolve the majority of concerns that arise out of patient and caregiver interactions.