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Nurses Create Escape Room to Increase Sepsis Awareness


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By Michelle Clarke

Over the past several years, themed escape rooms for team-building events has been all the craze.  And, thanks to some creative nurses, these RNs used an escape room concept for improving nurses and other healthcare professionals' knowledge about sepsis.

At least 1.7 million adults in the U.S. develop sepsis each year and nearly 270,000 die each year from that diagnosis, according to the CDC. Further, one in three patients who die while in the hospital have sepsis.

And while a recent survey conducted by the Sepsis Alliance found that sepsis awareness has increased in the U.S. significantly since 2017 (up 65% in 2018 from 58% in 2017), only 12% of adults can correctly identify all four symptoms of sepsis: higher- or lower-than-normal temperature, infection, mental decline, and extremely ill.

"One of the main reasons we decided to create an escape room was so we could include people who weren't nurses … without as much of a background with sepsis knowledge," Gabriel explains.
Why an escape room?

Paula M. Gabriel, MSN-RN, and Casey Lieb, MSN-RN, nurses at Penn Presbyterian Medical Center, a 355-bed acute care hospital in Philadelphia, and members of Penn Medicine Sepsis Alliance education team, were tasked with creatively educating their healthcare colleagues on sepsis awareness for World Sepsis Day last September.

The original idea for the escape room started in 2017 when Lauren McPeake, RN, BSN, created a simulation-based escape room to educate the nurses on her geriatric unit on the care of sepsis.

McPeake, a former emergency department nurse, noticed that sepsis wasn't being treated as a medical emergency on the unit, like it was in the ED. "I noticed frustrations around how many orders are generated when doctors think a patient is thought to be septic," she says. "I also noticed that people didn't understand why they were doing certain things, so I chose sepsis as the first simulation."

The simulation-based escape room was a hit with McPeake's colleagues, which sparked the idea of an interdisciplinary escape room for World Sepsis Day. As members of Penn Medicine Sepsis Alliance, Gabriel and Lieb thought an escape room where participants had to solve puzzles and riddles would be a fun and creative way for their colleagues to learn.

Gabriel and Lieb had the full support of leadership when discussing their ideas to promote sepsis awareness.

Members of the Penn Medicine Sepsis Alliance Education and Communications workgroup presented different ideas of how to promote sepsis awareness to the hospital board, and the board supported the idea of the escape room overwhelmingly.

"Most people that have been through an escape room thought it would be an interesting way to get the word out about sepsis awareness, and we also wanted to create buzz around the Sepsis Alliance," says Gabriel.
How the escape room works

A variety of healthcare professionals—social workers, physical therapists, physicians, nursing assistants, nursing students, members of the infection prevention team, and quality team staff—signed up online to participate in the escape room, according to Lieb.

In the Penn Presbyterian sepsis escape room, teams of six to eight people were locked in together and asked to use critical-thinking skills and teamwork to complete a mission to learn about sepsis. The teams had 25 minutes to detect and treat sepsis in a mock patient before they could escape the room. They did this by solving four puzzles and responding to clues.

One puzzle teammates had to solve involved an IV pump set up with four antibiotics that were tangled together and only two working IVs. The team needed to determine, with the help of distractors, which antibiotics to run and what order needed to be administered.

"The escape room format allows different types of learning, so you have people that are auditory, visual, or kinesthetic learners [and] they can touch things and talk through things. You have to use your critical-thinking skills and think outside the box," Gabriel says. "There's that pressure element of having to escape something in a certain amount of time and you know it's a different way of learning, compared to the traditional, ‘Come and sit in a classroom' and have somebody give you information."

The escape room was open from 5 a.m. to 2 p.m. to ensure that night shift workers could participate in the event, according to Gabriel. Gabriel and Lieb oversaw the escape room event throughout the day.

Once each team completed the mission (or in a couple of cases, some didn't), the teams debriefed with Gabriel, McPeake, and Lieb who informally evaluated the participants' understanding of sepsis. According to Lieb, the evaluations showed the participants had a better understanding of sepsis treatment after participating in the escape room.

Studies have found that training nurses on sepsis identification has positive outcomes. A Norwegian study found that after sepsis identification was integrated into nursing patient assessments, they found that early detection of sepsis slowed the progression of the disease and improved survival rates in a 30-day time frame.

Additionally, according to the American Association of Critical-Care Nurses, 80% of sepsis deaths can be prevented when patients receive a rapid diagnosis and treatment for sepsis.

During the debriefing, Gabriel and Lieb also explained the Penn Medicine Sepsis Alliance tools and internal website available for staff.                                                                                                                        

"We wanted people to know about our toolkit, the resources that we have for nurses, physicians, and staff so they can better educate themselves about sepsis and better understand what Penn's response is to the national sepsis crisis," says Gabriel.
Applying the concept into the future

"One of the great things about the escape room concept is that it is simplistic and can be applied to pretty much anything if you sit down and put some time into it," Lieb says. "It's a great tool for learning within a hospital setting. It's a great way to get people interested and have fun while they're learning something new as well."

The escape room was so popular across the healthcare disciplines, the nurses held a second day in October to accommodate the people who were unable to attend the first day. Based on this popularity, Gabriel and Lieb are considering using this concept in the future. Lieb thinks they will apply the concept to other topics and disease processes going forward.

"We've both been able to witness nurses and staff utilizing some of the tools from our toolkit that went through the sepsis escape room, so seeing it translated into practice is very exciting."