Interdisciplinary Process Improvement for Behavior Management of Acute Brain Injury.

BACKGROUND: Following a traumatic brain injury (TBI), 70% or more of patients display disruptive behaviors including verbal or physical aggression, wandering, nonadherence or care refusal, social withdrawal, and socially inappropriate behavior. These behaviors often worsen over the first few years after a TBI and place a significant strain on caring relationships. PURPOSE: Our brain injury program aimed to refine our inpatient rehabilitation programming approach, using the evidence base and provider expertise, to address disruptive behaviors among patients with TBI. METHODS: We formed an interdisciplinary committee, conducted one-on-one interviews and surveys, and participated in staff meetings. We based interventions on the premise that our TBI patients in the early stages of recovery required consistent environmental and interactional changes maintained by all members of the interdisciplinary team. We illustrate this approach with a case example. FINDINGS AND CONCLUSIONS: Our approach led to increased evidence-based behavior tracking, new health care assistant and nurse training, and improved team communication. Training was well received. Self-reported knowledge increased for all learners [ t (119)=-7.36, p <.001]. We saw increased event reporting on challenging behaviors, suggesting improved awareness of the need and opportunity for intervention. The Oversight Committee also received positive feedback about improved collaboration across disciplines.