BSO-DOS©

Behavioural Supports Ontario-Dementia Observation System

Worksheet

Step #1: Background (Complete prior to Data Collection Sheet)

Reason for Completing BSO-DOS©:
 Baseline/Admission  Implementation of a new strategy/intervention
 Transition/Move  Adjustment of medications
 New behaviour: _____________________________  Support for urgent referral/transfer
 Change in behaviour(s)  Other: ___________________________________
BSO-DOS© start date: ______________ Section completed by (print name): ____________________________________
BSO-DOS© stop date: ______________ Signature: ____________________________________
Step #2: Complete the Data Collection Sheet & highlight the numbers according to the colour-coded legend

Step #3: Analysis & Planning (Use completed Data Collection Sheet)

Total the Blocks Calculate the

Total the Concerns
for Each Day Average Hours
½ Hour Blocks
(Add up the number of blocks Per Day
for each category per day) (Add up the

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

Data Collection Sheet

*Mandatory column
Behaviour

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.