The effects of therapeutic activity kits in emergency department patients with dementia: Study protocol for a pragmatic randomized control trial.

Aim: To determine the effectiveness of therapeutic activity kits on health service use and treatment delivered in the emergency department (ED) in patients with pre-morbid dementia.
Design: Pragmatic randomized control trial with equal parallel groups.
Methods: Participants with dementia will be randomly assigned to the control group (N = 56) or the intervention group (N = 56). The intervention group will be given access to a therapeutic activity kit containing several different activities and sensory stimuli to engage the person with dementia during their ED stay in addition to usual care, and the control group will be given usual care only. A research nurse will observe participants at 30-60-min intervals throughout their ED stay for responsive behaviours, one-on-one nursing, and the use of chemical and physical restraint. This study has received Research Ethics Committee approval from the institutional review board and funding from the Rosemary Bryant Foundation (May 2019).
Discussion: Emergency departments are busy and noisy environments and can be intimidating and disorientating for patients with dementia, which can result in responsive behaviours. Responsive behaviours are often managed with restrictive interventions, such as chemical or physical restraint, or with constant bedside nursing (one-on-one nursing) to ensure patient safety. Alternatively, non-restrictive and non-pharmacological interventions that divert or occupy the attention of patients such as those contained in the therapeutic activity kit can be considered as a more person-centred strategy. Therapeutic activity kits have been reported as feasible for the use in ED; however, there is limited quality evidence at present to support the implementation of such interventions in the ED.
Impact: If this study is successful, it will demonstrate that a therapeutic activity kit containing activities (puzzles, colouring, music, and tactile activities) is inexpensive, easily implemented intervention that can prevent this patient group from demonstrating unsafe behaviours and requiring one-on-one nursing and restraints.
(© 2020 John Wiley & Sons Ltd.)