Pandemic Escape

Kristy Causey, MSN, RN
Gracia Boseman, RN, MPH

Picture it: An Acute Care Unit in 2019. Nurses administering medications with zero masks in sight. The only masks available are tucked away inside of dressing change kits. Two nurses discuss which specimen collection tube they should use for a patient with suspected sepsis. One nurse says, “I think I remember from the in-service that I read to use a gold top.” The other nurse states, “no, it’s an orange top. I remember because our team collected the wrong tube during the Escape Room, and we got a time penalty. It’s the reason we didn’t escape the room.” We, an Infection Prevention Nurse and an Educator, smile. There were many concerns related to outcomes when we started the rooms in 2017 but, in this moment, the outcomes are abundantly clear - the rooms helped a nurse collect the correct specimen on a patient and prevented a delay in care. Results like this inspire us, and others, to continue building the rooms.

Our last room evolved into a Pandemic Preparedness Escape Bus motivated by our Safety Team’s request to educate the facility on the functionality of Dual Use Vehicles, or mobile vehicles designed for emergent evacuation transport, and The World Health Organization’s¹ warning that a pandemic was not a matter of “if” but “when. The scenario provided to participants outlined that a pandemic overwhelmed our hospital and hospitalized patients needed transport to facilities that could accommodate overflow. Learner objectives built on 2017 – 2019 Infection Prevention Escape Rooms and emphasized proper use of PPE, the role of contaminated surfaces in disease transmission, proper collection of nasopharyngeal specimens and how roles would potentially change during a pandemic. Unlike other rooms, the bus expanded participation to incorporate non-clinical employees. In a 90-day post-survey, participants self-reported a 61% increase in handwashing, 21% increase in the proper use of personal protective equipment, and 23% increase in the awareness and cleaning of environmental surfaces. Three months later, COVID-19 would wreak havoc around the world and provide us with, what we hope will be, once in a lifetime outcomes. Our simulated scenario came to pass: Central Texas Veterans Health Care System employees took part in the mobilization of hospitalized patients and met community needs during the pandemic. Observations revealed that employees who participated in the Pandemic Escape Bus actively helped develop Covid-19 processes while employees who did not participate were still processing the reality and their role during a pandemic.

As we enter the “new normal”, and try not to despise that phrase, we are reflecting on the journey of Escape Rooms at our facility. It all began in 2016, when Grace attended a non-healthcare related Escape Room with her family and had an epiphany – use Escape Rooms to enhance infection prevention and control education. She approached Kristy and we embarked on the Escape Room journey together. We did not anticipate many challenges because of the abundance of fun Escape Rooms. We were wrong! In 2016, a literature search revealed very few articles on the use of Escape Rooms in healthcare education. We didn’t know where to begin. The rooms were fun and allowed for creativity, but we realized it was easy to lose focus. Our biggest tip is to maintain focus by using objectives to place clues. For example, we wanted to focus on the role that surfaces play in disease transmission, so we placed clues on high touch surfaces (e.g. handles and curtains). Another important tip is to measure the outcomes and continue to improve the learning platform.

Although escape rooms may seem like just playing fun games, when planned and executed carefully and methodically while also engaging as many of the senses in a learner-centered, team-based approached learning platform, it can be an effective educational tool in healthcare settings.

June 2022