St Peter's Hospital Case Study

Mr 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.

Mr A 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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