Introduction to P.I.E.C.E.S.
Janice Vance R.N/Bsc.N/ NUA
Knowledge CoordinatorBehavioural Consultant- IHA
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
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.
I follow P.I.E.C.E.S.- each time the resident’s
I use my P.I.E.C.E.S.-so each assessments the
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.
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
P.I.E.C.E.S facilitators are mandated to teach
the three day course as written and revised
by program faculty.
What is P.I.E.C.E.S?
A model for collaborative care and changing
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.
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.
What does P.I.E.C.E.S. stand for?
P- Physical- Imperative to rule out
treatable causes for changes in the
Drug induced Delirium, pain, infection
constipation and Polypharmacy are
frequently present in individuals with
chronic medical conditions.
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
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
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.
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
Promotes the team’s understanding of issues
prior to resident centered care planning.
P.I.E.C.E.S. 3 - Question Template
What has changed?
What are the risks and possible causes?
What is the action?
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
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
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
P.I.E.C.E.S is used throughout B.C and is embedded
in the BPSD Algorithm.
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
PIECES Jingle - music and lyrics by Patsy Cline, lyrics
adapted and song sung by Janice Vance