Currently, what will get physicians or psychiatrists grabbing for the prescription pad in dementia for a person living with dementia might be a need to prescribe a drug to produce a modest improvement in thinking, or a sub-domain of thinking such as memory. There’s been a drive, particularly since the famous report by Prof Sube Banerjee in 2009, to reduce the volume of inappropriate antipsychotic prescriptions. These antipsychotics were sometimes given inappropriately as a disproportionate chemical form of restraint, thus offending human rights, where other options might have been more suitable (for example finding out that a person with dementia had a treatable source of pain which could be treated appropriately.)
Whilst there’s a lot of hype to do with ‘change’, some of it unhelpful, some of the work in change is very helpful. I came across, via tweet from Helen Bevan, a very interesting activity called “BANNED“, from the Patient Safety and Quality Control Council.
— Helen Bevan (@helenbevan) April 14, 2017
I’d be very interested to hear of responses to this activity for the specific scenario where a clinical practitioner is unable to recommend or prescribe ANY medication for dementia. In the case of cognitive enhancers, these can have modest effect anyway (though it is worth noting for some the effect is significant and substantial).
I have therefore reproduced the activity instruction sheet accordingly.
“Sometimes turning your thinking on its head can be the best thing to do when trying to generate new ideas and solutions to old problems. The banned exercise gets you to create future scenarios based on imagining a world in which a product, service or experience no longer exists. It explores how people might adapt in this situation to generate new ideas and creative solutions.
- 30 minutes
- Groups of 6-8
- Flipchart paper for storyboards
- Marker pens
What to do
Decide on a scenario to investigate. For example, a world in which there is no medical treatment for dementia, for example there are no cholinesterase inhibitors or antipsychotics.
Determine time and scope for the scenario. For example, we begin when the person with dementia and care partner enter the room, with the person with dementia having been newly diagnosed with dementia.
Identify stakeholders. For example, patients, nurses, physiotherapists, occupational therapists, care aids, physicians, etc.
Create a storyboard by drawing your scenario. How would you adapt in your new world in which there were no medical treatment options for dementia? You might recommend memory aids or smartphone apps. Try to generate as many adaptations as possible.
Analyse the scenario through discussion. Explore your adaptations and how they might be put into practice.
Summarise insights. Discuss your adaptations and people’s reactions to them. Are any possible to test or implement?
- What did it feel like to imagine a world where medical treatment option no longer existed?
- Were you surprised by the ideas that you were able to generate?
- How could you apply this learning/experience in your work?”