An evidence-based practice project for recognition of clinical deterioration: Utilization of simulation-based education

Charyl Bell-Gordon, Elizabeth Gigliotti, Katy Mitchell


Background: As more complex patients are hospitalized, the need for highly skilled and competent nurses to recognize clinical deterioration becomes more apparent. The literature supports the use of simulation-based education to enhance the recognition of clinical deterioration. The purpose of this evidence-based practice project was to utilize simulation as an educational modality to improve the knowledge of registered nurses in the recognition of clinical deterioration among their patients.

Methods: This evidence-based practice project was conducted from May through June 2013 in a 900-bed facility. Participation was voluntary and included 15 medical-surgical, procedural, and post-anesthesia care unit registered nurses. Simulation-based education was utilized for assessing the recognition, management, and reporting of clinical deterioration by nurses while supporting learning in a safe environment. Each participant managed two simulated patients in deteriorating states. Baseline performance was obtained during the initial simulation scenario by utilizing RAPIDS, a validated tool that evaluates assessment, management, and clinical deterioration reporting. A post-simulation debriefing and education session occurred that included a review of all required critical action elements. Debriefing was followed by a second post-intervention simulated clinical deterioration scenario.

Results: The results indicated statistically significant improvement in mean assessment and management scores when the post-intervention results were compared with baseline [t (14) =2.04, p = .03]. Post-intervention reporting scores were also improved, although this change was not statistically significant.

Conclusions: Simulation-based education may be an effective strategy for impacting a nurse’s ability to recognize clinical deterioration and thereby allow for timely intervention.


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Journal of Nursing Education and Practice

ISSN 1925-4040 (Print)   ISSN 1925-4059 (Online)

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