Exploring the interaction between human factors within a new unit for acute behavioural disturbances via simulation

Ms Hayley Peek1, Ms Sarah-Louise Moyes1, Ms Kylie Fawcett1
1Royal Perth Hospital, Perth, Australia

The Urgent Care Clinic (UCC) is a newly opened unit at Royal Perth Hospital for the purpose of treating patients acutely under the influence of drugs and alcohol or with behavioural disturbance. The concept of the unit proved divisive amongst clinical staff which led the multidisciplinary management team to develop a system to examine the interface of human factors within the UCC. Human factors consist of the interactions between individuals at work, tasks at hand and the environment. With this in mind the team devised a strategy utilising simulation to observe and record these interactions. An interprofessional simulations team was formed which consisted of experts from Emergency Nursing and Medical groups, Simulation, Aggression and Prevention Intervention, Security and the Emergency Management Unit. The simulations were based on low frequency high acuity behaviours and included both behavioural and medical deterioration scenarios. The objectives were to test the environment, explore the systems and processes required, assess patient safety, review preconceived ideas of staff, empower a change towards positivity and engagement, familiarise staff with the environment and foster ownership of the UCC by clinical staff. Simulation exercises were repeated allowing for staff with varying skills, clinical experience and opinions of the area to participate. These were undertaken daily to get a cross section of staff.   Prior to each session the participants were orientated to the area and then given a pre-brief. All simulations members participated in a simulation debrief where participants were encouraged to reflect on the exercise and explore the objectives of the simulation. Interestingly, despite the different staff profiles used during the simulations, the same behaviours and issues were identified throughout. Undertaking simulations to engage staff prior to opening the area resulted in changes to staff perception, environment changes and streamlining processes to improve patient and staff safety.

Hayley Peek is currently the acting Clinical Nurse Specialist at Royal Perth Hospital Emergency Department. She has been working at RPH ED since 2006 and undertaken various roles including Clinical Nurse and Staff Development Nurse as well as policy work with the Clinical  Safety and Quality Unit. She is interested in quality improvement and education.

Sarah-Louise Moyes is the Nurse Unit Manager at Royal Perth Hospital Emergency Department. She has been working at RPH ED since 2004 and was previously the Clinical Nurse Specialist and Staff Development Nurse. Sarah-Louise is the president of the CENA WA committee. Sarah-Louise is passionate about staff welfare and patient safety.

Kylie Fawcett is the Simulation Educator for Royal Perth Hospital.  She has experience in emergency nursing and has been specialising in education for over 15 years.  She has been working in the emergency care speciality for 20 years. She has a keen interest in resuscitation and application of human factors in a variety of settings.