D INDIVIDUALISED DISTRACTION METHODS
The Care Cue Flower, sourced
from the Agency for Clinical
Innovation, was introduced at
the beside to individualise
a non-pharmacological
approach to managing
confused patients. Review
of these flowers indicated
there was a need for the
introduction of a Distraction
Tools Box.
Frank Sinatra playing
Hat from the Distraction Tools Box
9.64
0
11.19
14.44 14.79
4.76
0
4
8.06
3
April May June July August
20152016
10.01
3.96
Pre-implementation Post-implementation
FALLS PER 1000 BED DAYS
MEAN FALLS PER 1000 BED DAYS
2.8
1.8
Preimplementation Postimplelemtation
ART CALLS PER MONTH
SUCCESSFUL DISTRACTION
According to his Care Cue Flower, the confused patient
(below) had a history of wearing a hat daily and loved to
listen to the music of his era. Using this information, his
confusion was successfully managed using non-
pharmacological strategies. Contentment was maintained
by providing a hat from the Distraction Tools Box and
playing his favourite music by Frank Sinatra. Having these
recourses readily available enabled the staff on Med 1 to
create a safer environment for this patient and reduce their
workload commonly associated with a wandering patient.
DISTRACTION TOOLS
Using the data from the Care Cue Flowers over time, along
with staff and carer consultation, Distraction Tool Boxes
were developed to reflect values, beliefs, interests and work
history of the patient. The Med 1 team engaged in the
design, creation and implementation of the boxes
consisting of two male, two female and one unisex box.
Considering all stakeholders, this process involved the
collaboration with services such as infection control,
dementia and delirium specialists, medication prescribers
and community carer liaisons.
BACKGROUND
When Manly Hospital restructured in 2015, the Orthopaedic
Ward became the Acute Medical Ward 1 (Med 1). With this
came a rise in the number of confused patients presenting
with delirium and dementia. These patients were at risk of
harm to themselves and others through falls, aggression and
treatment interruption. Falls increased from 4.8 to 10 per
1000 bed days, and the number of Aggression Response
Team (ART) calls rose from a monthly average of zero to 2.8.
In response to these changes, an initiative using a non-
pharmacological approach to managing the confused
patient was commenced.
OUTCOME
The introduction of the distraction tools led to a decrease in
patient anxiety and an increase in contentment. Patients were
observed to remain calmer and willing to remain seated,
engaging in the distraction. This resulted in the reduction of
episodes of aggression related to confusion, pharmacological
restraint and falls. The development of this new practice
emerged through continuous collaborative reflection and action
planning. Ongoing evaluation of these strategies occurs through
consultation with nurses and carers. Nurses and carers now
report to be more equipped with the knowledge and resources
to non-pharmacologically manage the confused patient.
