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Description
From January 2018 to June 2020, there were 80 cases of children or their carers being exposed to threatening situations in Bohnice psychiatric hospital. In the same period, restraints were indicated in 157 cases.
Both issues were determined by analysing our own data. This project stems from the planned reform of psychiatry in the Czech Republic, where the National Action Plan for mental health 2020 – 2030 details the need for change in the education of health professionals.
The goal is to build, by simulation training of entire medical teams, greater confidence in dealing with acute situations, and via a considerate approach reduce the incidence of cases.
The simulations will operate in accordance with scenarios inspired by real events using child-like actors in a realistic environment, i.e. how medical teams would be forced to deal with those situations in reality.
First, we train 4 new lecturers of simulation medicine, create a methodology for the courses, and design 20 scenarios, e.g. self-harming, suicidal behaviour, aggression.
The Simulation Centre, where courses will take place, will then be equipped and 3 child-like (adult) actors impersonating patients will be trained via internships in the children ward and by script rehearsals.
Then we carry out a pilot course with 2 full teams from the children ward. Outcomes will then be used to realize 10 simulation courses, each of 12 hours (2 hours scene preparation, 8 hours course, 2 hours reaction feedback and further practice recommendations).
Finally, we will verify course efficacy by comparative analysis of the occurrence of undesirable events and use of restraints after course completion and compare it with pre-project data.
Up to 310 children and adolescents with mental disorders annually, and 55 medical caretakers, will profit from this project.
Summary of project results
The project aimed to improve healthcare for vulnerable child psychiatric patients by training professionals involved in their care. Innovative simulation medicine methods were employed facilitated by a unique simulation center that opened at Bohnice Psychiatric Hospital, one-of-its-kind in the Czech Republic. The implementation of the project was complicated by the Covid-19 pandemic, but the project was successful.
The project at Bohnice Psychiatric Hospital, run between March 2021 and June 2023, was divided into 10 key activities (KA). KA 1 trained four simulation course instructors. KA 2 developed and published a simulation course organization methodology. KA 3 created a booklet of twenty crisis scenarios. KA 4 equipped the new PNB simulation center. KA 5 involved actors rehearsing new scenarios and roles. KA 6 prepared a pilot simulation course. KA 7 held ten full simulation courses to train healthcare teams for child psychiatric patients. KA 8 evaluated and analyzed project data. KA 9 and 10 managed project publicity (including conferences) and covered the project management as such.
The project trained 78 health workers, with 95% finding it beneficial. Two key documents were published - the methodology and a set of scenarios. The simulation centre, equipped with 9 rooms and 4 trained actors, hosted 11 courses. An analysis showed that the need for the use of restraints in crisis situations among young psychiatric patients has decreased by about a third.
The project, part of the “Improving prevention and reducing health inequalities” programme, focused on often overlooked child and adolescent psychiatric patients. It aimed to reduce inequalities by training health professionals to manage crisis situations, thus minimizing adverse events like conflicts, assaults on staff, and the need for restraints. The materials and experiences from this project can be disseminated further, enhancing the overall impact.