Simulation Scenarios & Skills Checklists Bundle

Purpose

This scenario pack helps clinical teams rehearse high‑risk, low‑frequency events using reusable, locally adaptable scenario templates paired with observable competency checklists. Use these scenarios to surface system gaps, practice critical team skills, and reliably assess competence. Adapt each scenario to local protocols, equipment, and escalation pathways before running.

How to use this pack

1. Choose a scenario that matches a recognized local risk (e.g., sepsis response in the ED).
2. Customize the Setup Checklist to reflect your unit layout, equipment, medications, and documentation workflow.
3. Assign roles and brief confederates. Keep patient chart and meds realistic but clearly simulated.
4. Run a 10–30 minute scenario followed by a structured 15–30 minute debrief using the prompts below.
5. Score the competency checklist and record outcomes. Use results to plan follow‑up learning or process changes.

Included Scenarios (templates)

1) Sepsis Rapid Response — Ward to ICU

Overview: Adult patient with infection who deteriorates over 30–60 minutes with hypotension and altered mental status.

Learning objectives:

• Recognize early signs of sepsis and call for help appropriately.
• Initiate sepsis bundle elements (lactate, blood cultures, broad‑spectrum antibiotics, fluid resuscitation) within local target times.
• Coordinate escalation and prepare for transfer to higher level of care.

Setup checklist:

• Manikin or actor, monitor with vitals, IV access supplies, fluids, sample tubes, antibiotic simulated vials (labelled "SIM").
• Printed chart with recent temperature, WBC, possible source of infection, and baseline vitals.
• Phone or pager to simulate rapid response activation.

Roles: Primary nurse, bedside physician/NP/PA, rapid response nurse, unit charge, confederate family member (optional).

Timeline: 20–30 minutes scenario; expected escalation within first 10 minutes if recognized.

Critical actions / cues: Identify hypotension and rising lactate; call for help; obtain cultures before antibiotics if it will not delay therapy unreasonably; give appropriate fluid bolus; document and communicate transfer needs.

Debrief prompts:

• What cues led you to suspect sepsis? What delayed recognition, if anything?
• Which elements of the sepsis bundle were completed well? Which were missed or delayed?
• How did team communication and role clarity affect the response?
• Are there system barriers (supplies, order sets, lab turnaround) that should be addressed?

Competency checklist (example observable items):

• Recognized sepsis within X minutes.
• Activated rapid response/escalation pathway appropriately.
• Ordered and/or obtained lactate and blood cultures per protocol.
• Administered first fluid bolus (give volume and timeframe).
• Communicated plan and transfer needs clearly to team and receiving unit.

2) Airway Crisis — Unexpected Difficult Airway

Overview: Patient in procedural area or ward develops airway compromise requiring urgent advanced airway management.

Learning objectives:

• Apply recognized difficult airway algorithm used in your organization.
• Demonstrate clear team roles: airway lead, medication runner, oxygenation monitor, documentation.
• Perform alternative airway strategies (e.g., supraglottic device, cricothyrotomy) according to local policy or call for ENT/Anesthesia as indicated.

Setup checklist: Airway manikin with difficulty settings, video laryngoscope, bougie, supraglottic devices, cric kit, sedatives and paralytics (simulated), suction, oxygen sources.

Critical actions / cues: Recognize failing ventilation, escalate early, limit attempts per algorithm, maintain oxygenation, call for additional expertise timely.

Debrief prompts:

• How did the team follow the difficult airway algorithm? Were attempts limited appropriately?
• Was there closed‑loop communication around medication dosing and timing?
• What system supports or equipment were missing or hard to access?

Competency checklist (example):

• Established and communicated airway plan within X minutes.
• Used appropriate adjuncts and followed limits on attempts.
• Maintained patient oxygenation and hemodynamic monitoring throughout.

3) Medication Mislabeling Event — Wrong Drug at Medication Tray

Overview: Near‑miss or actual administration of a mislabeled medication identified by a team member or after administration (simulated).

Learning objectives:

• Demonstrate medication verification steps (rights of medication administration) and use of barcode or double‑check policies.
• Recognize and manage a discovered medication error immediately and report per policy.
• Identify latent system factors that contributed to the error (labeling, storage, distractions).

Setup checklist: Medication tray with one mislabeled syringe or vial (clearly marked SIM), medication administration record, barcode scanner if used clinically, distraction confederate to simulate typical interruptions.

Debrief prompts:

• What steps prevented or failed to prevent the error? How did team members speak up?
• What system changes could reduce this risk (par levels, labeling standards, physical layout)?

Competency checklist:

• Performed two‑person verification or used barcode scan per policy.
• Stopped administration when discrepancy discovered and escalated appropriately.
• Completed incident reporting/notification in simulation and discussed next steps.

4) Post‑op Hemorrhage — PACU Return to OR or Emergency Re‑intervention

Overview: Post‑operative patient develops hypotension and increasing drain output consistent with internal bleeding.

Learning objectives:

• Rapidly recognize hemorrhagic shock and initiate resuscitation and blood product ordering per massive hemorrhage protocol.
• Coordinate rapid transfer to OR or interventional radiology as required.
• Maintain team situational awareness and accurate documentation of volumes, blood administered, and timeline.

Setup checklist: Post‑op chart, wound/drain output props, IV/IO supplies, simulated blood products (labelled SIM), massive hemorrhage protocol reference.

Debrief prompts:

• When was hemorrhage recognized and what were the first actions?
• How well did the team manage communication, blood products, and transport logistics?

Competency checklist:

• Recognized signs of hemorrhagic shock and triggered protocol.
• Secured two large bore IVs/IO and administered initial resuscitation within timeframe.
• Coordinated timely OR/IR transfer and communicated essential handoff information.

Facilitator guidance

Psychological safety

Begin with a brief statement: this is a simulation, learning is the goal, and the debrief is a no‑blame environment focused on system and team learning. Encourage reflection and admit what is unknown. Offer opt‑out options for participants who feel uncomfortable.

Structured debrief approach

Use a short structured model such as: Reactions → Description of events → Analysis (what went well, what didn’t, why) → Summary and takeaways. Anchor debriefs to observable facts and system improvement opportunities. Identify one or two specific actions to follow up.

In‑situ vs lab considerations

• In‑situ simulations reveal system gaps (equipment access, communication pathways) but require careful scheduling and notification to avoid operational disruption.
• Use lab simulations to focus on skills or equipment use without clinical interruptions.
• When running in‑situ, notify leadership and have a plan for rapid conversion to real care if an actual patient emergent need arises.

Scheduling and logistics

Keep scenario runs short and predictable when using unit staff (e.g., 20–30 minutes plus debrief). Rotate staff through different roles across multiple runs to maximize exposure. Obtain local leadership support and protected time where possible.

Adapting to local protocols

Before running, customize order sets, time targets, escalation contacts, and expected medication names to match your local policies. Include a brief pre‑brief for participants highlighting any local deviations from the template.

Assessment, documentation, and improvement loop

Use the competency checklists to record observable performance and identify learning needs. Recommended practice:

• Score each observable item (e.g., Yes / Needs Coaching / Not Observed).
• Record results in a training log tied to learner records or unit improvement logs.
• Aggregate results periodically to identify system patterns (e.g., delays in antibiotic delivery, missing equipment) and convert into targeted process improvement actions.

Quick facilitator checklist (pre‑run)

• Confirm scenario customization to local policy and approval from unit leadership.
• Prepare props, sim medications labelled SIM, and functioning equipment.
• Brief confederates and assign observer(s) to complete competency checklists.
• Deliver pre‑brief emphasizing learning goals and psychological safety.
• Run scenario, facilitate debrief, and record action items and competency outcomes.

Templates included (copy & adapt)

• Scenario script and timings
• Setup checklist (editable)
• Debrief prompt list
• Competency checklist template with example scoring guidance

Use this pack as a starting point — customize, test, and iterate. Good simulation design balances realism with clear learning objectives and measurable outcomes. When used thoughtfully, these scenarios help teams practice responses, reveal latent safety risks, and build shared competence.