Innovation in sepsis education: an escape room model

Sepsis is a medical emergency, with 55,000 cases of sepsis and 5000 deaths occurring each year in Australia. ¹ International sepsis guidelines recommend the administration of first-dose antibiotics within 60 minutes of recognition as gold standard to reduce mortality. ² In Belmont Hospital Emergency Department, we have worked hard to implement a multimodal approach strategy to increasing the recognition of sepsis in the emergency department (ED). Regular retrospective audits, targeted education and the introduction of the Sepsis September Road Show have been effective, resulting in a reduction in time to administer first-dose antibiotics from over four hours in 2012 to approximately 41 minutes in 2016. ³

In 2020, we observed a decrease in compliance with the Adult Sepsis Pathway and so commenced a quality and safety improvement project with a view to identifying barriers to practice and improving recognition and response to patients with suspected sepsis. We found that high staff turnover was directly linked with reduced clinician knowledge, acting as a barrier to implementation of best practice. In addition, the rapid evolution of evidence-based practice in ED indicated the need to develop a more innovative method of engaging clinicians in sepsis education.^{2 4}

The Sepsis Escape Room

The Sepsis Escape Room (SER) was selected for this project based on research which suggests the application of ED methodology in clinical education has been successful in improving post-exercise knowledge of specific subjects. The sepsis escape room is a timed, interactive game where teams of clinicians work together to solve puzzles with a focus on improving compliance with the Adult Sepsis Pathway. Learning objectives include developing a comprehensive understanding of the tools and strategies available to flag high-risk patients at triage and recognising the importance of initiating and completing clinical pathways in goal-directed care.

Promoting problem-based learning

The goal was to develop and implement an innovative and exciting way of engaging clinicians in the process of clinical practice improvement by promoting a culture of problem-based learning in the ED. Further to this, it was important to develop a template that could be adapted to suit other specialties. The proposal was to implement the SER for World Sepsis Day 2022. The plan involved:

• undertaking a literature review and identifying key stakeholders
• identifying key resource people and working closely with clinical nurse educators to develop resources and test ideas
• identifying a minimum of four specific goals with measurable learning objectives for the project
• designing and delivering a pre-exercise questionnaire to assess the knowledge of staff selected to participate
• delivering the Sepsis Escape Room and seeking post-exercise feedback
• developing a template and delivering a poster at the 6th Nursing and Midwifery Conference in Newcastle, 2023.

Improvement in knowledge and understanding

Delivering the SER required positive engagement with senior executive leadership, the development of goals, clear communication with key stakeholders and flexibility. Despite receiving support to design and implement the SER, logistics pertaining to delivery proved challenging.

The SER had been proposed for World Sepsis Day in September, 2022. However, on the day, the high number of patient presentations combined with staff absence due to illness, prevented staff from leaving the ED to participate in the SER. This required rescheduling the SER for the following month.

Implementation of the SER required a coordinated effort by primary key stakeholders. While the clinical nurse educators had assisted to test ideas, their participation in the SER on the day was not guaranteed due to their obligation to respond to deteriorating patients on the wards. Through identifying this barrier, the support of two third year nursing students was enlisted to act in the role of patient and clinician.

We worked closely with the Nurse Unit Manager of ED to identify staff who could attend the SER and communicated regularly with participants to ensure pre-exercise questionnaires were completed. The creation of the props for the SER was the least challenging aspect of implementation and was funded through the senior executive leadership.

20 staff members participated in the SER, with 18 of those participants completing a pre and post questionnaire. Questionnaire results demonstrated an overall improvement in knowledge and understanding in the four areas of focus. Feedback was positive with 100% of participants rating the exercise 5/5. The escape room model of education has since been successfully adapted and used by the CNE team for new graduate nurses commencing at Belmont Hospital.

This project acknowledges the Australian Commission on Safety and Quality in Health Care's Sepsis Clinical Care Standard.

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