Since we started reducing George’s Seroquel dose, the evening shift nursing assistants began observing him more closely. They recorded their observations and then we met with his wife, Lois. We discovered that George became more agitated in the evenings following large group activities. He was calmer when there was less activity around. He would also react to the TV in the evenings, sometimes even yelling at it, like it was a person. Lois shared that George had little tolerance for the TV in the evenings at home. He preferred to listen to music or play cards, especially solitaire.
George is much calmer now that he has a consistent routine in the evening. Lois picked out some of his favorite songs and we loaded them on an iPod. Lois brought some headphones from home. George loves the music. You can hear George humming along to the songs. He also loves his cards. We have a quiet spot in the lounge where he can sit at the table and play solitaire. Some evenings he plays for hours or just shuffles the cards and lays them out. The nursing assistants keep the TV off in his room in the evenings and he never asks for it to be on. There have been no more outbursts or conversations with the television.
We seem to finally be at a good place with George. He has become calmer in the evenings. The nursing assistants tell me that now when they ask George if he’s ready for bed, he doesn’t resist them. He’s also sleeping better and seems happier. And the best news is, his doctor has discontinued the Seroquel. He even is more alert during the day without the Seroquel. Looking at the behavior logs, he hasn’t had an outburst or resisted evening care for a week now. It’s taken some work to get this far.
We haven’t had this success with everyone. Since seeing the changes with George, staff are more willing to try nonpharmocological interventions and problem solve for other residents. It takes a team effort! I wonder what changes can we make in our workflow to spread this success to other residents?