Bayshore Diagnostics
Yvonne introduced her friend Nancy Pilon, the Program Co-ordinator at the Diagnostic Centre. She holds a BA from U of T, a B. Sc. in Nursing from Lakehead and a Masters in Health Administration from Phoenix. She manages a staff of over 70 professionals, is on the Board of Directors of the National Association for the Dually Diagnosed and has been awarded numerous awards and honours.
Nancy said the purpose of their unit is to improve the lives of their patients. Bayview is one of 4 special care complexes in the mental health centre and it deals with the complex mental health needs and challenging behaviours of both in and out patients. The service is continual - intake analysis, therapy, follow up.
In 2001 Bill 85 mandated a focus on reducing restraints when dealing with patients. The unit developed measurable strategies but change required changes in philosophy, policy, environment and practice. The Act controls who is in care and how they can be returned to society and it dictates the levels of restraint allowed with a physical or mechanical device. These devices can range from a 6 point mechanical in which a patient is effectively rendered incapable of movement, through chemical restraints that deal with behaviours for the convenience of the care givers to environmental restraints such as a seclusion room.
In 2001 there were 1,029 incidents of mechanical restraints being used and in 2006 there were none. They still use rooms for seclusion. People had to internalize the change, accept the change in philosophy and change their attitude to realize a program that depended on proactive responses - reading the patients and anticipating situations and dealing with them before they became crises - rather than reactive ones. They also try to prevent behaviours by controling the environment.
As an administrator, Nancy is conscious of the decision made, the process as planned and the need to embrace an integrative approach using biomedical, phychological and environmental responses. New clinicians were hired to fit the new philosophy and practices were incorporated into the corporate culture. Eventually the restraints were removed completely from the beds and then the wards.
Service guidelines were developed for best practices and so that care givers would accept responsibility for timely care, person centered care and prevention and management of problematic behaviours. Safety has to come first and all changes in a patients behaviours have to be tracked and recorded for assessment and evaluation - it's a data driven program. The tools they have developed to enhance staff expertise and to develop quality patient outcomes are now recognized as national standards.
Movement between levels of privilege are evaluated, physical modification of the environment is ongoing, self evaluation is used - as when someone removes themselves to a seclusion room - greater visual stimulation has been introduced to the environment and staffing levels have been increased to provide constant supervision. All staff are constantly working to improve their skills. They try to implement interventions that reinforce patient choice and that are transferrable to the home environment because the ultimate goal is to release the patients. Currently they are the only centre in Ontario that does. Of course, this requires extensive follow up.
When they first started reducing the implementation of physical restraints, the use of seclusion took a big jump but now even that is declining dramatically. Incidents of staff injury and WSIB claims has dropped to almost zero. The program is now widely recognized internationally and they present to conferences and have won awards. It can be done elsewhere, aggressive behaviours can be changed and it's easier to modify the environment to facilitate these changes. The teams skills and confidence levels have increased and they are working to investigate other alternatives. They are no collaborating with their Provincial partners to eliminate all restraints in other facilities.
Steve thanked Nancy for an impressive presentation and complimented her and her team for their terrific efforts.