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About P.I.E.C.E.S.

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The Winnipeg Health Region is implementing a program that stresses creative solutions to managing dementia behaviours.

The program is called P.I.E.C.E.S., which stands for Physical, Intellectual, Emotional, Capabilities, Environment and Social. Under the initiative, health-care providers are taught to assess residents in each of the areas highlighted in the program's title. As a result, they are better equipped to manage the challenging behaviours of dementia patients - aggression, anxiety, calling out continually and wandering - without the use of medication, wherever possible. "It's a creative care planning and care provision strategy

that promotes positive resident behaviours, rather than staff focusing on the negative resident behaviours, which may lead to a reactionary response of prescribing antipsychotic medication," says Joe Puchniak, Manager of RAI/MDS and Decision Support for the Winnipeg Health Region's Personal Care Home Program.

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Puchniak says antipsychotic medications should be the last resort for treating dementia patients. Creative solutions like music therapy and pro-attention plans are the preferred first line of care, a point emphasized under P.I.E.C.E.S.

The Region, in partnership with the Alzheimer Society of Manitoba, is implementing P.I.E.C.E.S. across its entire long-term care program, but training the entire workforce, which is necessary for it to be effective, takes time. To expedite the process, the Region has launched an online training program available to all staff at all nursing homes in Winnipeg.

The online learning component of the website is part of the Executive Training for Research Application (EXTRA) project conducted by Puchniak and Cynthia Sinclair, Manager of Initiatives for the Region's Personal Care Home Program. The project was designed to determine whether it was possible to reduce the use of antipsychotic medication in treating dementia patients.

One of the training modules focuses on family communication. Sinclair says families of residents can be concerned about having their loved ones being placed on medications, especially antipsychotics, while others can be concerned about taking these medications away. The module on communication helps health-care professionals explain to family members the risks of the medications, as well as sending the message to families that it is "safe to ask" questions about care. Some important questions are:

  1. What behaviours are we trying to modify with the medications?
  2. What other methods have been tried?
  3. What are the risks associated with the medication?
  4. What are some of the side-effects of the medication; what symptoms should I be helping to look for when I visit?

The website can be used by the public, so families of residents can learn more about dementia and P.I.E.C.E.S. as a care model.

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