P10 Simulation training: management of acute behavioural disturbance in the acute hospital

Abstract

Background Research and training on acute behavioural disturbance (ABD) management focuses on psychiatric settings despite the prevalence of ABD in acute hospitals (3.6 incidents per 1000 A and E attendances1). Safe and effective care during these high risk situations requires clinical staff who are confident and skilled in managing patients with complex health and behavioural needs. We developed a high-fidelity simulation training course in managing ABD, tailored to the educational needs of acute hospital clinicians. Summary of work Recorded incidents of ABD requiring security staff input in November 2016 across all four hospital sites of Oxford University Hospitals NHSFT were reviewed to determine frequency and ‘hotspots’. 186 incidents were identified, 50 in A and E. A and E staff were then surveyed by questionnaires asking about experiences in managing ABD. 23/38 (61%) responded. Using this feedback we designed two high-fidelity simulation scenarios of ABD focusing on team-based approaches for practical risk management; including verbal communication and de-escalation techniques, rapid tranquilisation medication and restriction of liberty legislation. Training was provided on the acute hospital site, in the University of Oxford simulation centre (OxSTaR). Simulated scenarios were followed by structured debrief sessions, facilitated by a consultant liaison psychiatrist, to develop key learning points. Summary of results Seven training sessions were delivered in 2017–2018 to 74 doctors, nurses, midwives, pharmacists and security staff (mixed seniority). Participants completed pre- and post-training questionnaires (response rate 89% and 99%) incorporating nine training outcomes, with which they agreed or disagreed on a five-point Likert scale. Before: 7.6 (11.4%) participants disagreed and 16.4 (24.8%) agreed they met the nine outcomes. After: 1.2 (0.2%) disagreed and 31.1 (42.6%) agreed they met the nine outcomes. Discussion and conclusions This evaluation shows that high fidelity simulation training can improve the skills and confidence of acute hospital clinicians in managing ABD. Limitations include the small sample size and that post-training feedback was immediate rather than longer-term. Recommendations Simulation training in ABD management designed specifically for acute hospital environments should be made more widely available for acute hospital staff, for whom such training opportunities are limited despite how commonly prevalent they are and the impact on staff. Future evaluations can then include real-world incident reviews, to justify investment in this resource-intensive training. There may be scope to develop clinical scenarios that focus on other aspects of the mental-physical interface, tailored for acute trust clinicians to better meet the needs of patients with increasingly complex health needs. References Nikathil S, Olaussen A, Gocentas R, Symons E, Mitra B. Workplace violence in the emergency department: A systematic review and meta-analysis. Emergency Medicine Australasia2017;29:265–75. Management of acutely disturbed behaviour for adults (including rapid tranquilisation). Oxford University Hospitals NHS Foundation Trust Medicines Information Leaflet January 2017; Vol. 9, no. 6.