Document Type
DNP Project
Publication Date
2026
Degree Name
Doctor of Nursing Practice
Faculty Advisor
Kerry Milner, DNSC, APRN, FNP-BC, EBP-C; DNP
Practice Mentor
Kathleen Ackerman, MSN, RN, PCNS-BC
Abstract
Background
Early recognition of patient deterioration and timely activation of the Rapid Response Team (RRT) are critical to improving patient outcomes during medical emergencies. Nurses are often the first to identify clinical decline; however, barriers such as limited experience, uncertainty regarding activation criteria, fear of criticism, and inconsistent education may delay escalation of care and contribute to delayed treatment.
Project Goals
This EBQI project aimed to improve nurse confidence and readiness in recognizing patient deterioration and activating the rapid response team. Project objectives included providing simulation-based education sessions, achieving high staff participation, promoting use of a rapid response badge-based reference tool, improving nurse confidence in rapid response activation, and increasing the rate of appropriate rapid response activations.
Methods
The project was implemented on a 33-bed pediatric hematology/oncology unit at a private oncology hospital in the Northeast. A Plan–Do–Study–Act (PDSA) framework guided the intervention, which included tabletop simulation sessions, rapid response policy education, and introduction of a badge-based reference tool (“Badge Buddy”). Seven simulation sessions were conducted over three months for both day and night shift nurses. Evaluation measures included participation rates, badge buddy use, and pre- and post-intervention confidence surveys, and tracking of rapid response activations.
Results
Of the 70 nurses on the unit, 60 (86%) attended at least one simulation session, and 44 (73.3%) attended more than one session. Badge buddy use reached 96%, exceeding the target goal of 80%. Survey results demonstrated a substantial increase in nurse confidence, with “agree” or “strongly agree” responses increasing from 54.7% pre-intervention to 96.4% post-intervention. Nine rapid responses were called during the implementation period when compared to six, the two months prior. The highest rate occurred in October (5.78 per 1,000 patient days), while the lowest rates were observed in September (1.25) and December (1.34). Overall, RRT occurrence demonstrated variability across months without a consistent upward or downward trend. RRT data were obtained from clinical nurse specialist documentation and may not represent a complete capture of all rapid response events at baseline and during the implementation period.
Conclusion
Tabletop simulation combined with policy education and point-of-care reference tools was an effective strategy to improve nurse confidence in recognizing patient deterioration and activating rapid responses. Ongoing simulation-based education can support timely escalation of care in high-acuity clinical settings.
Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-Share Alike 4.0 International License.
Recommended Citation
Holtz, S. (2026). Tabletop simulation to improve rapid response activation and timely escalation in an acute pediatric oncology/hematology setting: An evidence-based quality improvement project. [Unpublished DNP project]. Sacred Heart University.
Comments
A DNP project submitted in partial fulfillment of the requirements for the degree of Doctor of Nursing Practice, Sacred Heart University Davis & Henley College of Nursing.