In-Situ Simulation Scenario Catalog — Starter Pack

Starter Pack — In-Situ Simulation Scenario Catalog

Use these three compact, ready-to-run in-situ scenarios to test systems, train teams in their actual environment, and surface latent safety threats (LSTs). Each scenario package contains learning objectives, required equipment and moulage, confederate/role guidance, a step-by-step trigger script, a short checklist of expected LSTs to observe, and focused debrief prompts that link observations to systems-level improvement opportunities.

How to use this pack

Pick a scenario that matches your local priorities. Run in the real patient care area with normal staff whenever possible. Keep runs short (10–20 minutes scenario + 20–30 minute structured debrief). Assign a simulation facilitator and a safety officer to pause or stop the exercise if real patient care or staff safety is at risk. After the debrief, capture actions and owners for follow-up.

Quick run checklist

• Confirm location availability and inform unit leadership.
• Identify facilitator, observer(s), and confederates.
• Prepare moulage, manikin or standardized patient, and required drugs/equipment (use simulation substitutes for real medications).
• Brief participants on safety pause and scenario limits.
• Run scenario and use a structured debrief that identifies LSTs, contributing factors, and immediate mitigations.
• Log findings and assign owners for corrective actions.

Scenario A: Acute Deterioration on the Medical Ward

Purpose: Practice timely recognition and escalation of physiological deterioration and evaluate rapid response processes.

Learning objectives:

• Early recognition of clinical deterioration (ABCDE and early warning scores).
• Effective team communication and role clarity during escalation.
• Timely activation and arrival of the rapid response team (RRT).

Required equipment & moulage: Ward bed, monitor (simulate abnormal vitals), oxygen, IV access supplies, simulation medication alternatives, standardized patient or manikin.

Confederate roles: Nurse (primary), bedside physician (if available), family member (optional), RRT responder(s).

Trigger script (outline): Patient on contact precautions post-op becomes increasingly tachypneic and hypotensive over 5–10 minutes. Nursing staff note declines; nurse pages primary but delays escalation; team must recognize deterioration, call RRT, and initiate basic resuscitative measures.

Expected LSTs to observe:

• Delays in escalation or unclear paging processes.
• Difficulty locating equipment or code carts on the ward.
• Ambiguity about roles (who directs airway, who documents).
• Documentation or EHR access delays during a crisis.

Scenario B: Medication Error — Wrong Dose Recognized at Point of Care

Purpose: Practice detection and recovery from medication errors, and examine system defenses (barcode scanning, double-checks, pharmacy verification).

Learning objectives:

• Recognize and halt an incorrect medication administration.
• Use clear communication to notify pharmacy/physician and manage patient safety.
• Capture the event data for systems analysis without punitive framing.

Required equipment: Medication labels (simulated), barcode scanner (or simulate scan failure), IV setups, medication administration record (paper or EHR simulated view), and standardized patient or manikin.

Trigger script: Nurse prepares and is about to administer an IV bolus; a confederate (pharmacy tech or nurse) notices an unfamiliar concentration or an unlabeled syringe. Team must stop administration, assess, and follow local medication error protocol.

Expected LSTs:

• Look-alike/sound-alike packaging or unclear labeling.
• Gaps between pharmacy verification and bedside administration.
• Non-standard single-check workflows under high workload.
• Unclear reporting pathway for near-miss events.

Scenario C: OR Fire Drill — Simulated Small Ignition

Purpose: Test OR fire response protocols, communication between circulating nurse, anesthesia, and surgical team, and patient evacuation readiness.

Learning objectives:

• Recognize signs of potential OR fire and apply immediate mitigation steps (stop, drop, disconnect sources).
• Practice team roles for patient safety and equipment protection.
• Confirm escalation and escalation pathways to facility safety/engineering.

Required equipment & safety notes: Use smoke-free visual cues (moulage or light and sound cues). No real smoke or combustible materials. Ensure fire alarms are not triggered; coordinate with hospital safety/engineering beforehand.

Trigger script: During electrocautery, a surgical drape 'smolders' (visual cue). Team must follow fire in OR checklist actions, protect airway, extinguish or isolate source, and prepare for possible transfer or evacuation.

Expected LSTs:

• Confusion about who disconnects airway circuits or secures the airway.
• Delays in portable extinguisher retrieval or unfamiliarity with extinguisher location.
• Unclear notification process to facility safety and anesthesia coverage gaps.

Structured debrief guide (systems-focused)

Use a consistent debrief structure to translate learning into improvements. Suggested flow: reaction – facts – analysis – systems actions.

1. Open with psychological safety: Remind participants this is for learning and system improvement, not blame.
2. Describe observable facts: What happened? Who did what? Keep focus on actions and timing.
3. Identify LSTs: Which latent threats or process gaps contributed? Prioritize 2–3 that are most likely to recur.
4. Root causes & contributing factors: Ask why those LSTs happened (staffing, labeling, EHR workflow, equipment location, unclear policies).
5. Agree actions: For each prioritized LST, capture a short corrective step, an owner, and a target date. Distinguish quick fixes from longer system changes that need escalation.
6. Close with positive framing: Highlight what went well and confirm follow-up communication to the unit and safety leaders.

Scheduling & safety considerations

• Coordinate with unit managers and facility safety to avoid interfering with real patient care.
• Use clear in-situ simulation identifiers and a safety pause signal.
• Document all LSTs in your chosen tracking system and report serious safety issues per policy.

Adaptation tips

Customize each scenario to local protocols, typical patient population, and known risk areas. Shorten or lengthen scripts depending on team experience. Consider pairing scenarios with brief microlearning modules that refresh key protocols immediately before the run.

End of pack. Use these scenarios as a starting point—capture local insights, update scripts, and share improved versions across units.