BSO DOS FINAL May 2019
BSO DOS FINAL May 2019
BSO DOS FINAL May 2019
Worksheet
Step #3: Analysis & Planning (Use completed Data Collection Sheet)
Frequency
(Divide the total ½
number of blocks
Duration
hour blocks by 10)
Day #1
Day #2
Day #3
Day #4
Day #5
for each category
Hint: Move the
over 5 days)
Risk
decimal point one
space to the left
1 Sleeping = ÷10
2 Awake/Calm = ÷10
3 Positively Engaged = ÷10
4 Vocal Expressions = ÷10
5 Motor Expressions = ÷10
6 Sexual Expression of Risk = ÷10
7 Verbal Expression of Risk = ÷10
8 Physical Expression of Risk = ÷10
9 = ÷10
10 = ÷10
What the BSO-DOS© data reveal (e.g. types of behaviours expressed, patterns, time of day, broken sleep): ________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Possible causes and contributing factors (consider collected context and personhood information): _______________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Next Steps (check all that apply):
Continue BSO-DOS© for another 5 days Medication adjustment/review
Repeat BSO-DOS© in 4-6 weeks Non-pharmacological interventions suggested:
No further BSO-DOS© completion at this time __________________________________________
ABC charting around particular events/behaviour __________________________________________
Clinical huddle/meeting Care plan updated
Progress note written Referral: ___________________________________
Consult/meet with Substitute Decision Maker (SDM) Other: _____________________________________
Section completed by (print name): ________________________ Signature: __________________________________
DOS Working Group (2019). Behavioural Supports Ontario-Dementia Observation System (BSO-DOS©).
Behavioural Supports Ontario Provincial Coordinating Office, North Bay Regional Health Centre, Ontario, Canada.
BSO-DOS©
Behavioural Supports Ontario-Dementia Observation System
Behaviour
Behaviour
Behaviour
Behaviour
Observed
Observed
Observed
Observed
Observed
Observed Behaviours
Context
Context
Context
Context
Context
Initials*
Initials*
Initials*
Initials*
Initials*
1 Sleeping
2 Awake/Calm
3 Positively Engaged
*
*
For #3-8 check as you observe:
D/M/Y
Activity Hugging
0700 Conversing Singing
0730 Hand holding Smiling
0800 Other:
0830 4 Vocal Expressions (Repetitive)
0900 Crying Questions
0930 Grunting Requests
Humming Sighing
1000
Moaning Words
1030 Other:
1100 5 Motor Expressions (Repetitive)
1130 Banging Grinding teeth
1200 Collecting/Hoarding Pacing
1230 Disrobing Rattling
1300 Exploring/Searching Rocking
1330 Fidgeting Rummaging
Other:
1400
6 Sexual Expression of Risk
1430
Explicit sexual comments
1500 Public masturbation
1530 Touching others - genitals
1600 Touching others - non-genitals
1630 Other:
1700 7 Verbal Expression of Risk
1730 Insults Swearing
1800 Screaming Threatening
Other:
1830
8 Physical Expression of Risk
1900
Biting Punching
1930 Choking others Pushing
2000 Grabbing Scratching
2030 Hair pulling Self-injurious
2100 Hitting Slapping
2130 Kicking Spitting
Pinching Throwing
2200
Other:
2230
9
2300
10
2330
2400 Context
0030 A Alone
0100 L Loud/busy environment
0130 Q Quiet environment
0200 F Family/visitors present
0230 C Personal Care (e.g. bathing,
incontinent care, toileting)
0300 N Nutrition - eating/drinking
0330 M Medication for behaviours given
0400 P Pain medication given
0430 T Treatment (e.g. wound care, creams)
0500 Expressions directed at
R
0530 Resident/patient/visitor(s)
0600 S Expressions directed at Staff
0630 X
Y
DOS Working Group (2019). Behavioural Supports Ontario-Dementia Observation System (BSO-DOS©).
Behavioural Supports Ontario Provincial Coordinating Office, North Bay Regional Health Centre, Ontario, Canada.