Feinstein Robert E, Yager Joel
University of Colorado School of Medicine, Aurora, CO, USA.
Acad Psychiatry. 2018 Oct;42(5):598-604. doi: 10.1007/s40596-017-0819-9. Epub 2017 Oct 30.
Violence in psychiatric outpatient settings is a ubiquitous concern. This article describes the development, implementation, and evaluation of a live threat violence simulation exercise, designed to reduce the risk of future outpatient clinic violence and minimize the effects of future incidents on staff.
The psychiatric outpatient clinic at the University of Colorado Hospital developed, implemented, and evaluated a 4-hour live violence threat simulation exercise as a companion to a 7-hour violence prevention program. The simulation includes an orientation, two threat simulation scenarios, three debriefings, satisfaction surveys, problem identification, action plans, and annual safety and process improvements.
The authors have conducted live violence simulation exercises from 2011-2016, and have collected survey data about our annual simulation exercise from 2014-2016. Each year ≥ 52% of participants responded, and each year ≥ 90% of respondents rated the simulation as "very helpful/helpful", ≥ 86% believed themselves to be "much better/better" prepared to deal with violent episodes, and < 2% of participants experienced post-simulation side effects such as worries about past trauma; anxiety; sleep problems; increase in workplace concerns. From 2011-2016, the clinic experienced 4 major violent episodes and 36 episodes of potential violence with no staff injuries and minimal psychological sequelae to one staff member. Violence prevention efforts and the development of close police/staff relationships may have contributed to these fortunate outcomes.
Satisfaction surveys suggest that the simulations are very helpful/helpful, with participants feeling much better/ better prepared to manage violence. The exercises led the authors to initiate staff safety related behavioral changes as well as physical space and safety processes improvements. The violence prevention program and simulation exercises have promoted excellent relationships with police and a consistent safety record over six years. This approach may be useful for other psychiatric outpatient departments.
精神科门诊环境中的暴力问题是一个普遍令人担忧的问题。本文描述了一次实时威胁暴力模拟演练的开发、实施和评估，该演练旨在降低未来门诊暴力事件的风险，并将未来事件对工作人员的影响降至最低。
科罗拉多大学医院的精神科门诊开发、实施并评估了一次为期4小时的实时暴力威胁模拟演练，作为一个7小时暴力预防项目的补充。该模拟演练包括一次情况介绍、两个威胁模拟场景、三次汇报总结、满意度调查、问题识别、行动计划以及年度安全和流程改进。
作者在2011年至2016年期间进行了实时暴力模拟演练，并收集了2014年至2016年关于年度模拟演练的调查数据。每年有≥52%的参与者做出回应，并且每年≥90%的受访者将模拟演练评为“非常有帮助/有帮助”，≥86%的人认为自己应对暴力事件的准备“好多了/更好了”，且<2%的参与者经历模拟演练后的副作用，如对过去创伤的担忧、焦虑、睡眠问题、工作场所担忧增加。从2011年至2016年，该门诊经历了4起重大暴力事件和36起潜在暴力事件，没有工作人员受伤，仅有一名工作人员出现轻微心理后遗症。预防暴力的努力以及警察与工作人员密切关系的建立可能促成了这些幸运的结果。
满意度调查表明，模拟演练非常有帮助/有帮助，参与者感觉应对暴力的准备好多了/更好了。这些演练促使作者发起了与工作人员安全相关的行为改变以及物理空间和安全流程的改进。暴力预防项目和模拟演练促进了与警方的良好关系，并在六年内保持了一致的安全记录。这种方法可能对其他精神科门诊部门有用。
