188 Community Simulation Program Designed to Improve Recognition of The Deteriorating Patient and Escalation of Care Pathways

Abstract

This abstract looks at how we implemented physical health simulations within community hospitals in late 2020 and more recently physical health simulation in mental health units.The objectives of these simulations were to improve the recognition of deteriorating patients and the appropriate escalation and/or transfer of care as well as ‘identifying latent errors through simulation’ We have run simulations in the community since October 2020 and in the mental health units in February 2021. These sessions have covered four main themes: SepsisHypoglycaemiaAnaphylaxisOpioid overdoseThese sessions were taken from pre-existing incidents such as the hypoglycaemic relative and anaphylaxis. We also added opioid overdose as this topic is relevant to both mental health units and community hospitals. We delivered a package of four simulations across 1 month at each unit. This allowed for a different simulation each week, regular learning outcomes and wider opportunity of contact with the staff working within these areas. These sessions were always well attended with staff even committing to learning on days off. This level of commitment shows a real desire to improve not only their own knowledge but also patient safety. We engaged over 50 staff on 9 separate sites (five community hospitals, four mental health wards). Staff have been very engaging and have really got behind these simulation sessions as well as the ward managers. By engaging both mental and physical health, it has helped to provide a wider audience of staff and helped to gain a parity of esteem across the trust in the provision of safety training and simulation. We have also identified a number of latent errors such as non-standardized provision of anaphylaxis adrenalin across the trust, staff unfamiliar with resuscitation equipment bags and equipment location within and identifying the lack of Glucagon within a Hypo box.The data collected from these sessions have shown a growth in confidence in identifying deteriorating patients and how to correctly implement and use escalation tools such as the sepsis pathway, electronic observations (E-Obs), anaphylaxis algorithms and the SBAR communication tool.These simulations have really allowed us to bridge the gap between the acute and community site, allowing for a greater parity of esteem for all patients. Further steps in this program will be delivering mental health simulations to all mental health units and community hospitals to further bridge the learning between physical health and mental health.