St Peter's Hospital - Paul's Journey

Paul, a 53 year old man referred from NHS PICU under Section 2, due to extreme challenging behaviour, including assault.

Nursed on continuous 2:1 observations and segregated from other patients due to his high risk of violence towards them. Paul had no community access and did minimal engagement with therapeutic activities. 

Referred to St Peter’s Hospital for the 16 Week Assessment & Treatment Pathway.  The assessment established:

  • a diagnosis of front temporal dementia
  • a need to manage emotional mobility, disinhibition, impulsivity and difficulties with speech and swallowing
  • implementation of a neuro-behavrioual approach in parallel with optimising effective psychotropic medication

Outcomes achieved:

  • reduction in the frequency and intensity of agitation, manifested in a change from 99 incidents in the first 8 weeks of admission to only 4 incidents in the last 7 weeks of the 16 Week Assessment & Treatment Pathway
  • reduction in levels of observation from 2:1 to 1:!
  • assessed as presenting with depressed mood, his improvement state enabled him to be able to consent to treatment with an antidepressant
  • engagement in a programme of therapeutic activity including cognitive stimulation, reminiscence therapy and community access
  • 2:1 support i the community with no adverse incidents and an improvement in mood and self-esteem
  • integrated into the general ward setting at St Peter’s
  • communication augmented through work with Speech & Language Therapy to develop and design a communication book assisting choices and decisions
  • currently in a transition programme back to him family home with is wife who has been actively involved in his rehabilitation with the staff at St Peter’s
  • training on a Package of Care & Positive Behavioural Management Plan provided to the family and locality team
  • home environment assessed by OT and Physiotherapy to ensure appropriate adaptations to the environment
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