The behviour of concen indicator was instituted as an ACQA indicator in 2009. The use of this indicator had been spasmodic and the ideas around using the incicator varied. One Site Eudunda Hospital had the idea that they did not want to see the behaviour of concern indicator turn into another incident logging tool, but into a tool that logged and monitored the managed behaviours that staff manage on a daily basis. On raising this concept of management at an ACQA forum it was decided to trial this tool in this way.

To determin if the clients or an organization would gain any benifit from monitoring managed behaviours in the ACQA indicators.

To make the behaviour of concern indicator relevent to ACQA members

The behaviour of concern indicator is not being used consistantly across the group of ACQA users, it is a need of ACQA to understand why this is not being used and how it will provide value to the users of ACQA. The Behaviour of concern indicator was launched in 2009 after extensive consulation and research.

The rational for the behaviour of concern indicator is

The aim of this indicator is to identify resident and organisation trends that will encourage members to identify improvements to reduce the risk of ongoing incidents of behaviour of concern (ACQA Guidelines)

Then we need to define what is a Behaviour of Concern?

Definition:A behaviour of concern is any behaviour that is causing distress, risk or actual harm to either the resident, or others.(ACQA Guidelines)

Behavioural management is an ongoing monitoring and maintenance process which is captured in care planning and in the exceptional reporting. The residential care manual states that

Behavioural management—The needs of residents with challenging behaviours are managed effectively. (Residential Care Manual Commonwealth of Australia 2009 pg 55).

It was agreed at an ACQA forum meeting that behaviour was more than a single incident and its management but a complex aray of statergies that were employed daily to ensure that the incidents did not happen. This management plan my be born out of incident management but it becomes an intrinsic and elemental aspect of the work that is done with the clients by nursing staff and carers.

With every aspect of care that is provided in residential care the Aged care standards are the final word in what out comes we should achive and Outcome 2.13 Behavioural management - Results - Management demonstrates its approach to behavioural management is effective in meeting residents needs, then in the processes, How does the home evaluate and review behavioural management practices in meeting needs of the residents.

Using the behaviour of concenr indicator as a measuring stick of problem behaviours that are managed satifys this outcome and would take the monitoring of exisiting behaviours to a new level of consistent review and monitoring.

Use of the behaviour of concern indicator to capture known behaviours of clients and use this as a monitoring tool of behaviours that are managed in a facility.

The monitoring of managed behaviours in secure dementia sites to see if this benifited the clients with care outcomes and also the organization in planning for care.

These sites capturing all behaviours documented in care plans on the indicator and using this as a way of checking off known behaviours vs incidents to see if through this monitoring the everyday management of clients behaviours are acknoledged, interventions more frequently reviewed

At Eudunda the Care plan recorded behaviours were placed on to the indicator tool. This showed that number of behaviours that were managed and highlighted how much work went into the maintenance of residents with significant behaviours as compaired to the rates of incidents. It also showed that there is a period of trial and error that exists on the arival of a new resident. In this period there are more incidnets registered that lead to care plan changes and initatives. Alternativly several incident based care plan issues were able to be reviewed and the interventions that were orriginaly applied reviewed with the goal of minimal intervention.

Issues that evolved were that the descriptions of the behaviours were not broard enough

With the accumulation of six months of information it has shown the behaviour of concern indicator as a valuable management tool to be aware of the impact that residents are having on the work load of the facility and this has been a valuable addition to the evidnce that has justified increased staffing levels at certain problamatic times. From a clinical perspective it has allowed the monitoring of care plans more frequently than the monthly review. It has taken the impact of behaviours from a part of nursing that is just accepted by the staff of a facility to a measurable and demonstatable element of the overall work of a favcility. This way of managing the behaviours process has proved to be a way of processing and keeping behavioural incidents in check. As we all know the best predictor of future behaviours is past behaviours and this sit well with that concept.

Residents have behaviours reviewed more regularly and the oppertunity for interventions are seen earlier

Refining the language of the behavioural indicator