In‑Situ Simulation Scenarios, Facilitation Checklists & Debrief Templates

Purpose

This toolbox helps simulation educators design and run in‑situ simulations that reveal latent system risks while building team competence. It provides ready scenarios, facilitator checklists, a structured debrief that surfaces system issues, and a simple method to capture, prioritize, and close out latent safety threats (LSTs).

When to use

Use these scenarios for routine in‑situ sessions, orientation or onboarding drills, just‑in‑time training before high-risk procedures, or focused safety campaigns. Recommended cadence: monthly sessions for clinical units with moderate-to-high acuity; adapt frequency to local risk and staffing realities.

Scenarios included (ready-to-run)

• Rapid-response airway emergency

  Learning objectives: recognize airway compromise early; escalate appropriately; coordinate roles (team leader, airway operator, medication nurse); practice equipment selection and backup plans; practice closed‑loop communication.

• Sepsis recognition & bundle initiation

  Learning objectives: early sepsis screening and recognition, rapid initiation of sepsis bundle (labs, cultures, fluid resuscitation, early antibiotics), role coordination with pharmacy/lab, timely documentation, and handoff to higher level of care.

• Pediatric deterioration

  Learning objectives: use pediatric early warning escalations, weight‑based medication dosing and equipment sizing, family communication during escalation, and timely activation of pediatric response resources.

• Transfusion reaction

  Learning objectives: identify signs of transfusion reactions, stop transfusion safely, initiate emergency management, coordinate with blood bank and lab, and complete required reporting and documentation.

What each scenario contains

• Clear learning objectives (clinical, team, and system-level)
• Roles and role scripts (including suggested confederate prompts)
• Short scenario script with triggers and expected cues
• Equipment and supplies checklist
• Patient and environment safety considerations
• Structured debrief guide with system-focused questions
• LST capture template with suggested categories and prioritization method

Facilitator prebrief & psychological safety

• Welcome participants and state the learning goals clearly: clinical skills, team coordination, and system improvement.
• Explicitly create psychological safety: simulations are for system learning, not judgement of individuals. Ask for permission to observe and record LSTs for improvement, explain who will see those reports, and describe how anonymity will be handled if appropriate.
• Clarify patient safety boundaries: what actions are not permitted, how to pause or stop the scenario if real patient care interruptions occur, and where staff can find immediate clinical guidance if needed.
• Confirm roles and expected time commitment, and review basic confidentiality expectations.

Facilitator checklist (day-of)

• Confirm scenario goals and key observation points
• Confirm room is safe and equipment is functional (see equipment checklist)
• Confirm confederates understand their prompts and timing
• Assign an LST recorder and clarify capture categories
• Confirm debrief facilitator and time allocation
• Ensure plan to escalate critical safety findings immediately (phone numbers, on-call leaders)

Equipment & environment checklist

• Simulation manikin or standardized patient, monitors, oxygen, suction
• Airway equipment: laryngoscopes (adult/pediatric), supraglottic devices, bougie, cric kit
• Resuscitation medications and mock syringes or stickers for simulation
• IV/IO access supplies, blood products (simulation labels), tubing
• Defibrillator/pacing pads with training mode configured
• Recording device (if used) and LST capture form (paper or digital)
• Clear signage to prevent real‑world interruptions (or agreed procedure to pause for real patients)

Safety considerations

• Protect patient care: ensure simulations do not displace real patients or supplies needed for actual care (e.g., occupied resuscitation carts should be restocked immediately).
• Avoid using medication intended for patient care; use clearly labeled simulation supplies.
• If a simulation participant recognizes a real patient need, stop the scenario and attend to real care first.
• Be mindful of emotional safety when scenarios involve pediatric or traumatic content; offer a brief check-in after debrief for participants who feel distressed.

Structured debrief template (facilitator prompts)

Use a consistent structure to keep the debrief psychologically safe, focused, and system-oriented.

• Opening (set the frame) — Reiterate objectives, remind participants that we are learning about systems and teams, not blaming individuals.
• Reaction — Invite participants to share immediate reactions and emotions (1–2 sentences each).
• Analysis (what happened) — Use advocacy‑inquiry to explore key actions: "I noticed X happened when Y occurred, and I'm wondering what you were noticing?" Focus on observable behaviors and decisions tied to system context.
• System-focused exploration — Ask targeted questions that reveal latent gaps (see list below).
• Summary & takeaways — Agree on concrete next steps, owner(s), and timeframes. Close with a positive reinforcement and a brief plan for follow-up.

System-focused debrief questions (examples)

• Were critical supplies and equipment available and in expected locations? If not, how did that affect care?
• Did team roles and responsibilities match what is expected by policy or local practice?
• Were there any confusing or ambiguous protocols that delayed care?
• How did communication with ancillary services (lab, radiology, pharmacy, blood bank) perform?
• Did documentation or the EHR workflow support quick, safe care? Were there bottlenecks?
• What training gaps became visible? What knowledge or skills could mitigate the issue?
• Were staffing levels or task allocation a limiting factor in managing the event?
• Could any immediate mitigations reduce risk before a permanent fix is implemented?

Latent Safety Threat (LST) capture form (template)

Capture discrete LSTs during observation or debrief. Use the fields below to make LSTs actionable.

• Description: Short title and clear description of the issue
• Category: Communication, Equipment/Supplies, Medication, Process/Policy, Training, Environment, EHR, Other
• Clinical impact (severity): Minor / Moderate / Major
• Likelihood to recur: Unlikely / Possible / Likely
• Suggested immediate mitigation: What can be done now to reduce harm?
• Suggested long-term fix: Policy change, retraining, redesign, equipment purchase, EHR change
• Suggested owner: Role or department to own follow-up
• Target resolution timeframe: e.g., immediate, 30 days, 90 days
• Notes / evidence: timestamps, screenshots, photos (if allowed), and staff statements

Prioritization rubric (simple risk score)

Turn LST captures into prioritized actions with a simple risk score: Severity x Likelihood = Risk Score.

• Severity: Minor=1, Moderate=2, Major=3
• Likelihood: Unlikely=1, Possible=2, Likely=3
• Risk Score: 1–3 Low, 4–5 Medium, 6–9 High
• Use Risk Score to determine next steps: High = immediate escalation to safety committee and rapid mitigation; Medium = assigned owner and 30–60 day plan; Low = monitor or include in scheduled improvements.

From findings to fixes (recommended process)

1. Log each LST to a central register (paper form, spreadsheet, or electronic tracker).
2. Assign owner and target resolution date based on prioritization.
3. Define an immediate mitigation if needed, then plan a short PDSA (Plan-Do-Study-Act) cycle for the long-term fix.
4. Report high-risk LSTs to the patient safety lead and appropriate committees immediately.
5. Track closure and share results back with clinical teams to close the learning loop.

Suggested 60-minute session timeline (example)

• 5 minutes — prebrief, clarify goals and safety frame
• 10 minutes — set up and role assignments (including LST recorder)
• 10–15 minutes — run the scenario (time to be adapted by scenario)
• 25–30 minutes — debrief and capture LSTs, agree actions and owners
• 5 minutes — closeout, logistics for escalation and next steps

Facilitation tips & common pitfalls

• Keep the focus on systems and processes rather than individual blame; explicitly name when a problem is a system issue.
• Limit the number of observers to avoid crowding and performance pressure; use video or a single observer when possible.
• Use short, scripted confederate prompts so scenarios are repeatable and comparable across runs.
• Document LSTs during debrief while they are fresh; don’t rely on memory.
• Close the loop visibly: report what changed as a result of prior simulations to build trust and encourage participation.

Suggested metrics to track over time

• Number of simulations run per unit per month
• LSTs captured per simulation (and percent closed by target date)
• Time-to-mitigation for High risk LSTs
• Participant feedback on psychological safety and perceived usefulness
• Downstream process performance measures linked to LSTs (e.g., door-to-antibiotic time if sepsis LSTs are addressed)

Templates provided (copyable)

• Full scenario scripts (editable)
• Facilitator prebrief script and checklist
• Equipment checklist (printable)
• Paper LST capture form and prioritization worksheet
• Debrief guide with facilitator prompts and suggested system questions

Preserving intent and avoiding harm

This toolbox is designed to surface system risks and improve team performance, not to single out or shame individuals. Use it with clear governance for LST data, a plan for escalation, and a commitment to visible follow-up so staff see improvements that result from their participation.

Capability enhancement notes (recommended)

To make this toolbox more operational and easier to scale across units, consider the following platform-enabled enhancements:

• Interactive LST submission form so observers can enter LSTs during debrief and store them centrally (use the Content Data Submission capability).
• Render the LST form as an interactive HTML form so facilitators can submit and track closure status and owners directly from the session page.
• Package the scenarios and tools as an ownable toolkit so sites can copy, tailor, and version them to local processes and policies.

References & further reading

• Debriefing with Good Judgement and Advocacy‑Inquiry techniques
• Society for Simulation in Healthcare (best practices)
• Local patient safety reporting policies (link to org-specific resources)

Use: run routine in‑situ sessions, capture latent safety threats, convert findings into prioritized fixes, and track closure to improve systems and build trust.