PIECES - Not a Cake or Pie!


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This presentation was delivered in session F4 of Quality Forum 2014 by:

Janice Vance
Regional Knowledge Coordinator Residential Services
Interior Health

Published in: Health & Medicine
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PIECES - Not a Cake or Pie!

  1. 1. Introduction to P.I.E.C.E.S. Janice Vance R.N/Bsc.N/ NUA Knowledge CoordinatorBehavioural Consultant- IHA Residential
  2. 2. Objectives  Learn the P.I.E.C.E.S. Jingle.  Understand the concept of P.I.E.C.E.S.  Become familiar with the 3-Question Template
  3. 3. Ode to P.I.E.C.E.S  Written/sung by Janice Vance/HarmonyLundguist         I follow P.I.E.C.E.S.- each time the residents’ change; I use my P.I.E.C.E.S.- so each assessments the same, Referrals had shown that you’d done it all, Was nursing care your call ? They’re hiring at the mall, But when we all used the P.I.E.C.E.S tools, Good outcomes always came when our efforts pooled, Yes it’s true all goes well when best practice rules , We welcome each one of you to the P.I.E.C.E.S school.
  4. 4. I Fall to P.I.E.C.E.S
  5. 5. P.I.E.C.E.S. Jingle  I follow P.I.E.C.E.S.- each time the resident’s change  I use my P.I.E.C.E.S.-so each assessments the same.
  6. 6. Origin of P.I.E.C.E.S  In 1998 Ontario Gov’t taught a system-wide approach that would facilitate best practice for registered staff working with dementia and mental health care residents (P.I.E.C.E.S.)  From 1999 -2007 program expanded to include unregistered staff, acute care hospitals and community care case managers.
  7. 7. Origin of P.I.E.C.E.S cont.  The program was very successful and  P. I. E.C.E.S Canada began training facilitators in several provinces including B.C.  P.I.E.C.E.S facilitators are mandated to teach the three day course as written and revised by program faculty.
  8. 8. What is P.I.E.C.E.S?  A model for collaborative care and changing practice.  A framework for understanding the multiple causes as to why a resident behaves the way he or she does.  A learning resource for staff that provides clinical knowledge and practical tools to help the team find a solution.
  9. 9. Why P.I.E.C.E.S ?  This successful model offers staff:  Common vision, approach and set of values.  Common language for communicating with other residential teams/ programs .  Tools and methods that ensure a standardized team approach to the assessment.
  10. 10. Examples of Tools  Cohen-Mansfield Agitation Inventory (CMAI),  Dementia Observational System,  Clock Drawing Test,  Cornell Scale for Depression
  11. 11. What does P.I.E.C.E.S. stand for?  P- Physical- Imperative to rule out treatable causes for changes in the health/behaviours.  Drug induced Delirium, pain, infection constipation and Polypharmacy are frequently present in individuals with chronic medical conditions.
  12. 12. P.I.E.C.E.S cont.  I- Intellectual- Assessing for dementia related cognitive changes, loss of abilities in specific defined areas and changes in communication.  E- Emotional- Assessing for changes in mood, multiple losses and past history of mental health issues.
  13. 13. P.I.E.C.E.S cont.  C- Capabilities- Assess for changes in usual strengths and abilities to meet basic needs. Discuss resident engagement in life routines.  E- Environment- Observe and discuss changes in resident’s physical and social environment. Include changes in resident population and unit culture.
  14. 14. P.I.E.C.E.S cont.  S- Social- Who is the resident in terms of their life story? What was their life like prior to moving to long term care?  Discuss changes in resident’s social support system. Identify change in family dynamics, death of significant others and disruption in familiar life patterns.
  15. 15. The 3-Question Template:  Guides the team in a systematic assessment- the “Huddle “.  Shapes team dialogue by asking questions that prevent members from jumping to solutions too quickly.  Promotes the team’s understanding of issues prior to resident centered care planning.
  16. 16. P.I.E.C.E.S. 3 - Question Template What has changed? What are the risks and possible causes? What is the action?
  17. 17. The “UnPieces” Assessment Middle aged patient with Bipolar illness/manic phase on PSCU Needed seclusion with only mattress and locked bathroom After lunch behavior escalated approx. 3 times/week; given prn Primary nurse, behavioral clinician and psychiatrist had meetings Could not find a “Trigger” for escalation as not a daily event By accident primary nurse noticed new P/T housekeeper in room Observed new cleaner unlocked BR to let patient in (not allowed) Primary nurse questioned cleaner who spoke little English She said…………………………………………………………………………………….
  18. 18. The P.I.E.C.E.S Assessment  87 year old, married man (60 yrs.) admitted to LTC,  Confused, wandering, trying to take female resident to     his bed every day in the late afternoon, Staff believe that he is a sexual predator and send referral to Behavorial Consultant for help, P.I.E.C.E.S review done at facility, Social revealed that when staff spoke to resident’s wife She said…………………………………………………………………
  19. 19. Summary P.I.E.C.E.S ensures each area of the resident’s life is evaluated before making a decision as to why the change in behavior has occurred P.I.E.C.E.S values the input of the resident’s family and team. P.I.E.C.E.S is used throughout B.C and is embedded in the BPSD Algorithm.
  20. 20. QUESTIONS OR COMMENTS? Thank-You
  21. 21. Resources and Acknowledgements  P.I.E.C.E.S.-Putting the PIECES together, 6th Edition (R), (2010) Adapted by Janice Vance R.N/Bsc.N/NUA  2014  PIECES Jingle - music and lyrics by Patsy Cline, lyrics adapted and song sung by Janice Vance