• Kristen M Brown, Shawna S Mudd, Julianne S Perretta, Adam Dodson, Elizabeth A Hunt, and Kristen Nelson McMillan.
• Kristen M. Brown is an assistant professor and the advanced practice simulation coordinator, Johns Hopkins University School of Nursing, and the simulation strategic projects lead, Johns Hopkins Medicine Simulation Center, Baltimore, Maryland.
• Crit Care Nurse. 2021 Feb 1; 41 (1): e1-e8.

BackgroundSimulation is increasingly used to identify latent threats to patient safety, such as delays in recognition and management of time-sensitive conditions. The Rapid Cycle Deliberate Practice teaching method may facilitate "nano" (brief) in situ simulation training in a critical care setting to improve multidisciplinary team performance of time-sensitive clinical tasks.ObjectiveTo determine whether nano-in situ simulation training with Rapid Cycle Deliberate Practice can improve pediatric intensive care unit team proficiency in identifying and managing postoperative shock in a pediatric cardiac patient.MethodsA quality improvement educational project was conducted involving nano-in situ simulation sessions in a combined pediatric and pediatric cardiac intensive care unit. The Rapid Cycle Deliberate Practice method was used with an expert-driven checklist for 30-minute simulation scenarios.ResultsA total of 23 critical care providers participated. The proportion of time-sensitive tasks completed within 5 minutes increased significantly from before to after training (52% [13 of 25] vs 100% [25 of 25]; P ≤ .001). Using a 5-point Likert scale, with higher scores indicating higher levels, the participants reported high degrees of performance confidence (mean, 4.42; SD, 0.20) and satisfaction with the simulation experience (mean, 4.96; SD, 0.12).ConclusionThe Rapid Cycle Deliberate Practice method was used to facilitate nano-in situ simulation training and identify areas requiring additional education to improve patient safety. In situ simulation can educate providers in a cost-effective and timely manner.©2021 American Association of Critical-Care Nurses.

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