Dr Emer Forde,1 Dr James Bromilow,2 & Professor Clare Wedderburn1 [1]GP Education Centre, Bournemouth University; [2] Poole Hospital NHS Foundation Trust Managing emergencies in the community: Taking simulation out of the classroom and into real-life …Seen many examples of helpful verbal behaviour being ruined by inappropriate non verbal behaviour. ( Byrne and Heath Family GPs should be trained to better understand and monitor their own non-verbal behaviours towards patients. (Marcinowicz) Intervention was effective in increasing stuedents awarenessof NVC but it was not sufficient to chsnge the actual performance. Furtehr research is needed to explore whether additional training would actually improve their `NVC performanace.(Ishikawa) 5. Br J Gen Pract. 2010 Feb;60(571):83-7.Patients' perceptions of GP non-verbal communication: a qualitative study.Marcinowicz L, Konstantynowicz J, Godlewski C. 6. Ishikawa H et al Can Nonverbal communication skills be taught? Medical Teacher 2010; 32: 860-863 Introduction GPs have a responsibility to provide prompt and effective care in an emergency. However, life threatening emergencies in the community are rare and can therefore provide a challenge for doctors in keeping up-to-date and maintaining confidence. Although, primary care staff are currently required to undertake regular Basic Life Support training, most emergencies are peri-arrest situations and this is an area where GPs lack confidence (Ramanayake et al., 2014). The aim of this project was to upskill clinicians in managing emergencies that could occur in GP surgeries. Classroom based simulation has a track record for teaching and often used for BLS courses. However, clinicians need to be able to use their own equipment and medication, and be confident managing emergencies within their surgeries. This highly innovative project brought simulation out of the classroom and into community environments where emergencies actually occur creating ‘real-life’ scenarios. Summary of work Simulation comprised 2-3 hour workshops based in GP surgeries, led by a GP and Consultant in Intensive Care Medicine. Scenarios included the practical management of meningitis, anaphylaxis, hypoglycaemia, convulsions, choking, asthma, croup, chest pain and cardiac arrest. The novel aspect of this work was that participants had to find and utilise equipment in their surgery and were asked to physically draw up the appropriate medication. 31 primary care staff (28 doctors and 3 practice nurses) have participated across 5 surgeries in Dorset. There are an additional 6 workshops booked as part of this project. Pre and post workshop confidence ratings, and qualitative feedback on the value of ‘real-life’ simulation based teaching, have been collected. Impact on doctors confidence Participants’ self rated confidence in managing medical emergencies increased after attending the workshops. Overall, during the simulations doctors knew in theory what to do but couldn’t quickly and safely demonstrate competence in the scenarios. For example, experienced doctors struggled to draw up life saving medication such as benzyl penicillin for meningococcal meningitis and adrenaline for anaphylaxis. Others took several minutes to find and turn on the oxygen cylinder in their surgery. What was useful? Participants generated 56 comments on what they found useful. The majority (57% comments) were on the value of the practical aspect of the teaching. “Learning how to use the oxygen cylinder” “Practically handling emergency equipment” “Actually drawing up doses” “Epipen use” “The need for knowing how to use our own equipment” “Relevant practicalities – this made teaching so much more tangible”. Participants also valued the clinical teaching and scenario based approach (34% comments). “Remember glucose” “ABCD and AVPU assessments” “Emergency section in BNF “Really useful to use scenarios” Participants also commented on the importance of a supportive environment and the overall value of the workshop (14% comments). “Non-threatening and very useful session” “Not made to feel stupid” “Recognition that is rare and hard to know it all” “This was brilliant” “I learnt lots and everything was useful” Participants were also asked ‘what was less useful’ and ‘any other comments’. They did not report any feedback on areas that were not useful and additional comments focused on the need for further ‘real-life’ simulation training for managing emergencies in the community. ““I hope this can be done regularly as it will make a huge difference to patient care” “Disseminate to all GPs and practice nurses” Longer term impact The longer term impact of this work is being assessed through feedback collected 8 weeks after each workshop. To-date, feedback has been received from 8/14 participants. 100% respondents reported making a change, either personally or within their practice, following the workshop. “We updated our emergency drug ampules” “We copied the back pages of the BNF so that we have quick access to emergency drug doses. The laminated pages are in our emergency bags and attached to our resus trolley” “We have organised individual emergency boxes which are equipped with the emergency drugs we might need to have quickly when dealing with the more common GP emergencies. Each box is clearly labelled” “Adjusted the layout of the crash trolley. Printed out algorithms for common emergencies to keep in the crash trolley along with dosing information” “Review of emergency drugs, identifying whereabouts of emergency kit” Participants self rated confidence 1 (not confident) – 9 (very confident) Before After How confident are you in the practical management of emergencies within your practice? 4.5 7.1 Workshop feedback Very poor – poor – satisfactory – good – very good Highest rating How relevant was the teaching to your needs? Very relevant 100% How would you rate the teaching within the scenarios? Very good How would you rate this education event overall? Conclusions Most of the participants knew the theory of what to do in emergencies but lacked the practical skills and confidence to efficiently manage scenarios. This included very experienced GP and younger GPs who had recently undertaken hospital (including A&E) rotations. Participants highly valued the practical, simulation based aspect of the teaching. GPs need educational opportunities to practice their skills. We suggest that mandatory BLS training needs to be extended to include peri-arrest emergencies. Training also needs to be taken out of the classroom and into real-life environments. This is particularly important for time critical illnesses where delays can have a direct impact on morbidity and mortality. Acknowledgments This work was funded with a simulation grant from Health Education Wessex. Our thanks to Dr Susie Jackson, Dr Sheona Chapman, Dr Chris Loew, Dr Henrik Reschreiter for their support and for running some of the workshops. Reference Ramanayake, R., Ranasingha, S. & Lakmini, S. (2014). Management of Emergencies in General Practice. Journal of Family Medicine and Primary Care, 3(4), 305-308. For further information please email Dr Emer Forde at eforde@bournemouth.ac.uk