Implementing a behaviour management approach in the hospital setting for individuals with challenging behaviours during acute traumatic brain injury

Block, H.1,2, Sarah C. Hunter1, Michelle Bellon1 and Stacey George1

1 Southern Adelaide Local Health, SA Health, 2Division of Allied Health, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, Australia 


Behaviours of concern in acute traumatic brain injury (TBI) present risks including harm to patients, equipment destruction, and workplace violence. This study aimed to determine if implementing a clinically pragmatic behaviour management approach for behaviours of concern in acute TBI reduces use of restraints, security incidences, acute length of stay admission and cost, thereby improving progress to rehabilitation. The intervention group (n = 23) consisted of acute TBI patients exhibiting behaviours of concern who received a behaviour management approach at two acute hospitals in South Australia, compared with a historical control group from both sites (n = 74). Fidelity results demonstrated high level of adherence to the implemented behaviour management approach. Intervention group had significant lower use of mechanical restraints (p = 0.03), and significantly lower acute admission costs (p = 0.034). Trends in lower pharmacological restraint usage, lower acute hospital length of stay and time from admission to rehabilitation acceptance were recorded. These pilot results contribute to improving quality of health care. Future studies are required to investigate evidence-based behaviour management interventions for acute TBI patients using rigorous knowledge translation implementation designs.

Heather Block

Heather Block is an occupational therapist and PhD Candidate. She has extensive clinical experience working as a clinical lead occupational therapist with adults with neurological conditions. Heather is a PhD Candidate with Caring Futures Institute at Flinders University. Her PhD studies are investigating management of challenging behaviours after traumatic brain injury. Heather has experience in clinical education and lecturing in Occupational Therapy at Flinders University and coordinating research projects at Southern Adelaide Local Health Network.

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