Psychiatry, Security, and SIMPeds – A Patient and Staff Safety Collaboration

Posted on February 28, 2018
Authored by Martha Butler, RN, PMHCNS


BCH cares for highly complex patients including children and adolescents with a wide variety of psychiatric and behavioral disorders. Behavioral emergencies are unique in that the patient’s emotional regulation and behavior constitute the emergency and the staff’s interpersonal therapeutic interventions are key to managing the crisis and keeping all in the environment safe.


The Joint Commission on Accreditation and CMS the US government healthcare regulatory authority is raising standards related to the care and safety of individuals with behavioral health issues regardless of where they may present. Inpatient Psychiatry Leaders, Dr Eleni Maneta, Martha Butler RN, PMHCNS and Cheri Sinclair BSN, RN along with BCH Security Leaders Captain Ray Moses and Ann DiCorcia  began  a collaboration with SIMPeds’ Matt Taylor and Chris Roussin  to create simulations of behavioral emergencies with symptom profiles that include dysregulated mood and disruptive behavior. Different from medical emergency situations, in behavioral emergencies the patient is a conscious participant in the incident. Clinicians have learned from debriefing psychiatric patients and their families over time that patience and caring communication with the individual in crisis is what is most appreciated. While the Psychiatrist and Psychiatric Nurses coordinate the clinical interventions and decision making, a Milieu Counselor or Security Officer may be the professional whose calming words the patient is best able to respond to.


This team designed and implemented a Zone 3 Pilot Simulation of a behavioral emergency in the Sim Lab in November. An actor experienced in medical simulation work played a key role. Communication between providers and security and the actor drove the simulation’s progression of events rather than expert medical interventions. The care scenario involved an adolescent male inpatient who had become upset during a family meeting with his parents and team members. Nursing Staff provided the initial response and summoned Security staff and a Psychiatrist to collaborate in managing the emergency.


The psychiatry team has identified several areas for process improvement as a result of post pilot debriefing. SIMPeds staff provided consultation which we will utilize to inform our process improvement including adding the role of Event Manager, who will refrain from active intervention and globally assess and  support the communication and intervention handoffs. Next steps include local Zone 2 trainings and planning and scheduling subsequent Zone 3 simulations. Our goal is to improve our collaboration while taking advantage of the unique professional role orientations and strengths of our BCH behavioral responders.