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Module Three Oxford Medical Simulation Guidelines and Rubric
Jennifer Andrews
Southern New Hampshire University
NUR 409: Strategies for Quality Improvement
Doctor Brittney Mueller
September 21, 2025
, 2
Healthcare Problem Identified:
In the Melanie Slater simulation, there was a failure to call a Rapid Response promptly
during an acute anaphylactic episode. Additionally, unsafe medication practices were identified,
including:
Failure to follow the 5 Rights of Medication Administration, the incorrect IV fluid
selection not matching the prescribed order, and the administration of a non-prescribed drug can
be potentially harmful.
These errors highlight gaps in emergency response protocols, medication safety, and
clinical decision-making under pressure, all of which can lead to significant patient harm in real-
life settings.
Proposed QI Initiative:
"Implementing an Interdisciplinary Simulation-Based Training and Safety Protocol for the
Emergency Management of Anaphylaxis"
Goals of the QI Initiative:
Enhance recognition and escalation for anaphylaxis, including mandatory Code Blue
activation.
Standardize the use of the 5 Rights of medication administration through targeted
training.
Improve interdisciplinary communication and SBAR reporting, especially around patient
background and medication handovers.
Reduce medication errors by improving confidence in IV fluid and medication selection
under time pressure.
Proposed Interventions:
Regular multidisciplinary simulation/in-person training for anaphylaxis scenarios, with
real-time feedback (Mock anaphylaxis codes).
Introduce a visual prompt or checklist for anaphylaxis management at bedside (wall
chart, EMR pop-up).
Integrate a "5 Rights Medication Safety Pause" before any emergency medication is
administered.
Establish a mandatory debrief and reflective practice session post-emergency cases to
promote continuous learning.
Metrics to Evaluate Improvement:
Module Three Oxford Medical Simulation Guidelines and Rubric
Jennifer Andrews
Southern New Hampshire University
NUR 409: Strategies for Quality Improvement
Doctor Brittney Mueller
September 21, 2025
, 2
Healthcare Problem Identified:
In the Melanie Slater simulation, there was a failure to call a Rapid Response promptly
during an acute anaphylactic episode. Additionally, unsafe medication practices were identified,
including:
Failure to follow the 5 Rights of Medication Administration, the incorrect IV fluid
selection not matching the prescribed order, and the administration of a non-prescribed drug can
be potentially harmful.
These errors highlight gaps in emergency response protocols, medication safety, and
clinical decision-making under pressure, all of which can lead to significant patient harm in real-
life settings.
Proposed QI Initiative:
"Implementing an Interdisciplinary Simulation-Based Training and Safety Protocol for the
Emergency Management of Anaphylaxis"
Goals of the QI Initiative:
Enhance recognition and escalation for anaphylaxis, including mandatory Code Blue
activation.
Standardize the use of the 5 Rights of medication administration through targeted
training.
Improve interdisciplinary communication and SBAR reporting, especially around patient
background and medication handovers.
Reduce medication errors by improving confidence in IV fluid and medication selection
under time pressure.
Proposed Interventions:
Regular multidisciplinary simulation/in-person training for anaphylaxis scenarios, with
real-time feedback (Mock anaphylaxis codes).
Introduce a visual prompt or checklist for anaphylaxis management at bedside (wall
chart, EMR pop-up).
Integrate a "5 Rights Medication Safety Pause" before any emergency medication is
administered.
Establish a mandatory debrief and reflective practice session post-emergency cases to
promote continuous learning.
Metrics to Evaluate Improvement:
