3.2.3. Challenges Faced

Identified challenges with in situ simulation included (1) lack of dedicated space to conduct simulations and debriefings and inadequate space to store all the equipment; (2) technical and time consuming challenges of setting up for each simulation and debriefing; (3) interruption of simulations/debriefings by events occurring in the unit (i.e., high census, high acuity); (4) ensuring adequate participation. Monthly multidisciplinary simulation and debriefing sessions were offered on each shift. Initially, they were offered on weekends as well, but there was less participation on weekends. Varying days and times simulation/debriefing sessions were offered throughout the month encouraged staff participation. Dates and times of all scheduled simulation and debriefing sessions were emailed and posted in advance allowing staff to plan ahead. Early in the process, it was difficult to achieve physician and nurse practitioner participation since scheduled times mostly occurred in the afternoon or evenings when HCPs had already completed their shift for the day. In order to increase physician and nurse practitioner participation, session times were moved to accommodate rounding schedules and ensure multiple physicians were present on the unit to attend simulations and provide patient care as needed. They were also timed around typical breaks for nurses and respiratory therapists to enable them to participate.
