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K20 Riskmanagement by the early recognition method in patients with huntington’s disease
  1. Henk Slingerland1,
  2. Daniëlle Brands1,
  3. Femke Drost1,
  4. Marije Verhoef1,
  5. Lia van Gelder1,
  6. Karen Lammertsen1,
  7. Tom Stor1,
  8. Frans Fluttert2,3,4,
  9. Els Verschuur1,5
  1. 1Huntington Expertise Centre Atlant, Apeldoorn, The Netherlands
  2. 2FPC Dr. S. van Mesdag, Groningen, The Netherlands
  3. 3Oslo University Hospital, Oslo, Norway
  4. 4Molde University College, Molde, Norway
  5. 5HAN University of Applied Studies, Nijmegen, The Netherlands


Background The most common behavioural problems in patient with Huntington’s disease (HD) are addressed adequately by nurses aiming to avoid escalation or crisis. However, in case aggression or escalation is imminent, it is important to identify early warning signs of aggression. The Early Recognition Method (ERM) is a risk management strategy developed in psychiatric care, aiming to improve collaboration between nurses and patients in order to prevent aggression.

Aim To explore the feasibility of ERM Risk Management by recognition of early warning signs and monitoring behaviours from stability to deterioration in HD patients in a long term care facility.

Methods The ERM strategy is described in the ERM-protocol. In a training program the nursing staff learned to apply the protocol. In weekly evaluations early warning signs of aggression are explored and discussed between nurses and patients. When early warning signs arise, nurse and patient carry out early interventions in order to stabilise patient’s behaviour. The effects of applying ERM will be studied by comparing the number of incidents in the period before and after ERM is implemented. Outcome measures are: number of incidents, team climate (EssenCES) and behaviour (BOSH).

Results ERM was introduced on 2 Skilled Nursing Facilities. All nurses followed the training program and they showed enthusiasm to apply the ERM protocol in clinical practice. The first experiences are positive. However, due to communication issues, not in all eligible cases the early warning signs were discussed with the patients. In those cases, nurses just shared their observations within the team.

Conclusions The preliminary results suggest that ERM may contribute to effective behavioural management for nurses in HD patients living in a long term care facility.

  • behaviour
  • early recognition
  • risk management

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