a. Leveraging Patient Safety Attendants (PSA) for delirium and neuropsychiatric symptoms (NPS) management in hospitalized older adults

Background: Delirium and NPS of dementia are associated with multiple negative outcomes in hospitalized older adults. Pharmacological agents offer limited efficacy, with high rates of complications. Multicomponent non-pharmacological approaches for their prevention and management are considered more effective in their management. PSA/ sitters are utilized by hospitals for one-to-one observations of safety and behavior management of these patients, but evidence shows that despite their use the rate of chemical and physical restraint use remains high. Our hypothesis is that training PSAs on delirium and NPS of dementia and providing tools to engage patients can enable them to manage these conditions. Methods: Intervention: We created a 90-minutes workshop curriculum comprised of two components. IN the first part, we teach PSAs the difference between delirium and NPS of dementia, and 4AT delirium tool and in the second part, they learn from occupational therapist, strategies to cognitively re-orient a patient using items in an activity box, environmental clues to avoid behavior escalation, ways to engage in mobility and self-care. After PSA training, the project was piloted in one of the medical wards and survey data collected pre, post -workshop, and in 6 months. RESULTS: Seventeen PSAs were trained, female (94%), Black (80%), with average age ranging from 25- 60 years. Pre-workshop survey indicated PSAs reported “aggression” and “agitation” as most problematic behaviors (confusion, agitation, aggression, socially inappropriate behavior and wandering). In 6-months follow-up, 5 PSA left the hospital. Survey of the 12 PSAs indicates continued improvement in all behaviors but only “socially inappropriate behavior” was statistically significant (p<0.05) and only 55% reported using activity box. Conclusion: This study highlights that our curriculum can significantly improve the knowledge and skills of PSAs in the recognition and management of delirium but increase its adaptability we need close follow up with the PSA pool.