In‑Situ Simulation Scenario Library Starter Pack

Welcome — How to use this Scenario Library

This starter pack helps educators run in‑situ simulations that reveal latent system risk and build team skills. Each scenario is designed to be adapted to your setting: change patient demographics, available equipment, team composition, timing, or injects to surface local system issues. Read the scenario fully before scheduling, run a short pre‑brief to set expectations and psychological safety, and use the provided debrief prompts to focus on systems and teamwork rather than individual blame.

Core structure for every scenario

• Learning objectives — clinical and systems (what participants should demonstrate and what system vulnerabilities you want to reveal).
• Recommended participants — roles to include and useful observers.
• Setup checklist — location, equipment, medication props, scripted chart data, EHR notes, and moulage.
• Scenario flow — timeline, initial state, triggers, and suggested injects.
• Debrief prompts — open questions to explore actions, cognition, teamwork, latent conditions, and improvement opportunities.
• Suggested metrics — what to measure after the run to track system risk and improvement.

Scenario: Cardiac Arrest on the Ward

Learning objectives

• Demonstrate rapid recognition of cardiac arrest and initiation of high‑quality CPR according to local protocol.
• Coordinate roles for compressions, airway, defibrillation, medication, and documentation.
• Identify system barriers: arrest team activation delays, equipment access, code cart layout, EHR documentation, communication with family/bedside staff.

Recommended participants

Ward nurse(s), primary team physician or resident, rapid response/Code team responders, respiratory therapist, charge nurse, patient care assistant.

Setup checklist

• Manikin with simulated monitor, defibrillator with training pads, functioning code cart stocked per local standard (or accurate mock).
• Simulated chart including early warning scores, prior vitals, and current meds.
• Room arranged as typical ward room, clear pathway to door for stretcher transport.

Scenario flow

Patient on telemetry becomes unresponsive. Initial rhythm: ventricular fibrillation. Allow 30–60 seconds before Code team arrival to test recognition and use of immediate defibrillation. Injects: delayed oxygen delivery, missing defib pads in the usual spot, EHR password delays, family member at bedside asking questions.

Debrief prompts

• What cues led you to recognize cardiac arrest? How quickly was the arrest team activated?
• Were there barriers to retrieving or using the defibrillator? Why did they occur?
• How were roles assigned and communicated? What worked and what could be clearer?
• What system or process changes would reduce time to first shock and improve coordination?

Suggested metrics

• Time to recognition, time to first compression, time to first shock.
• Number of equipment retrieval delays (defib/airway) per run.
• Number of communication breakdowns documented during debrief.

Scenario: Sepsis Deterioration in the ED or Inpatient

Learning objectives

• Early recognition of sepsis and prompt initiation of sepsis bundle elements (lactate, blood cultures, fluids, timely antibiotics).
• Test handoffs and escalation pathways when a patient deteriorates.
• Surface system issues: lab turnaround times, antibiotic availability, order sets, and communication across teams.

Scenario flow

Patient with fever and hypotension arrives; initial treatment is incomplete. Over 15–30 minutes the patient worsens. Injects: delayed lab results, pharmacy stockout, unclear ownership between specialties, missing sepsis order set in EHR.

Debrief prompts

• How did you identify sepsis risk? What diagnostic or therapeutic steps were delayed and why?
• Were there system-level reasons for delay (labs, meds, orders)? How could the pathway be made more reliable?

Suggested metrics

• Time to lactate, time to first antibiotic, percent completion of sepsis bundle.
• Count of system causes (e.g., order set not found, pharmacy delay).

Scenario: Emergency Department Trauma Triage

Learning objectives

• Apply primary survey priorities and rapid decision‑making for disposition (OR vs CT vs resuscitation bay).
• Coordinate multi‑disciplinary team activation and communications with radiology/OR/trauma surgery.
• Reveal process gaps: pre‑notification, trauma activation criteria, communication with imaging, and equipment readiness.

Scenario flow & injects

Multi‑trauma arrival with unclear mechanism and unstable vitals. Injects include delayed trauma activation, stretcher positioning problems, and radiology unavailable for a short window.

Suggested metrics

• Time from arrival to trauma activation, time to CT or OR decision, availability of necessary equipment (airway, chest tube kits).

Scenario: Medication Error Recovery in a Ward Setting

Learning objectives

• Detect and respond to a wrong‑medication event, prioritize patient stabilization, disclosure, and error reporting.
• Explore system contributors: look‑alike/sound‑alike packaging, storage practices, EHR picklist design, pharmacy workflow.

Scenario flow

Patient receives an incorrect dose of a high‑risk medication. The scenario focuses less on rare catastrophic harm and more on recognition, mitigation, timely reversal if appropriate, transparent communication with patient/family, and reporting.

Debrief prompts

• How did the error occur? What defenses failed? What opportunities exist to redesign systems to prevent recurrence?
• How was the disclosure handled? Were reporting pathways used correctly?

Suggested metrics

• Time to error recognition, time to reversal/mitigation, occurrence of unsafe storage or labeling practices identified.

Scenario Template (copyable)

Use this template when creating additional scenarios:

• Title
• Setting
• Clinical learning objectives
• Systems learning objectives
• Recommended participants and observers
• Required equipment and setup checklist
• Initial patient state and script
• Injects and timing
• Debrief prompts (teamwork, cognition, system factors, improvement ideas)
• Suggested metrics and data to collect

Practical tips to avoid common 'mal hungers'

• Keep runs short and purposeful — avoid busywork that drains staff without producing insight.
• Focus debriefs on systems and latent conditions; use advocacy‑inquiry to explore why people acted as they did.
• Ensure psychological safety: reassure participants that the goal is system learning, not punishment.
• Document findings as actionable items with owners and follow‑up dates.
• Repeat scenarios with tracked changes to confirm system improvements.

Collecting data and next steps

After each run capture objective metrics (times, equipment delays), qualitative observations, and participant feedback. Consider using the platform's interactive form capability to save post‑simulation feedback and create a running database of vulnerabilities and improvement actions.

Safety and governance

Coordinate with clinical leadership and risk/patient safety before in‑situ runs. Notify affected units, label simulations clearly, and provide a rapid stop signal. Debrief with relevant stakeholders and escalate identified system risks to safety committees.

Appendix: Quick setup checklist

• Confirm leadership notification and unit awareness.
• Prepare manikin, monitor, and defibrillator (training mode).
• Prepare patient chart and EHR simulation data.
• Confirm moulage, medication props, and documentation forms.
• Assign observer(s) and debrief lead.
• Plan data collection: timings, observed system failures, participant feedback form.

Where this library can grow

This starter pack is intentionally portable — teams should copy and tailor scenarios for specialty units, pediatrics, behavioral health, and ambulatory clinics. Consider packaging common scenarios and data fields into an owned toolkit so sites can version and track improvements over time.