Iowa City staff use ‘escape room' training to address safety - VHA SimLEARN
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Iowa City staff use ‘escape room' training to address safety

By Emily Peters, MSN, RN
Simulation Coordinator REdI Program Director
Iowa City VA Medical Center

IOWA CITY, Iowa – Staff at the Iowa City VA Medical Center (VAMC) developed an “escape room” scenario to address patient safety from a root cause analysis investigation by patient safety nurses that showed more training was needed to better prevent falls in inpatient units. The education was initially begun in February to coincide with Fall Awareness Month. Iowa City staff use the MORSE Fall scale as a documentation form that nurses use to assess if a patient is a high fall risk. If the patient has a specific number on the scale, then staff will take special precautions to help prevent falls.

For the escape room scenario, the Fall Committee Chairs and Education Department decided on the following objectives:

  1. Accurately Score the MORSE Fall Risk Assessment.
  2. Implement appropriate interventions based on the assessment score.
  3. Recognize potential hazards that could cause a fall.
  4. Use Introduction, Situation, Background, Assessment, Recommendation (ISBAR) correctly when communicating effectively.

The team researched the use of escape rooms for education purposes, and they discovered an abundance of information regarding escape rooms and elementary education. According to Brown, Darby & Coronel (2019), escape rooms promote learning through teamwork and problem solving. Brown et al. (2019) stated, “there is a potential to gain information about the development of key nursing competencies, such as delegation, teamwork and collaboration, with this type of teaching strategy.” Adams, Burger, Crawford and Setter (2018) mentioned that an active learning approach is critical for adult learners, and it is essential to consider the resources needed to implement such a practice change. This type of learning is also essential to help with collaboration and teamwork.

Several meetings between the Education Department and the Fall Committee chairs noted important points to drive home during the simulation. They also discussed room and equipment set up, group size and the use of allotted time during work hours. They decided to use a standardized patient instead of a mannequin, so the patient scenario was developed keeping the standardized patient in mind.

A list of clues and riddles were created first, which was said to be one of the more challenging tasks. Then the educators determined how many puzzle pieces were needed. The educators then had to create a riddle and determine the clue that would go with that riddle to move the participant on to the next part of the room.  

The clues or riddles were developed to have the participant answer different parts of the fall scale. After completing the task at hand, they would be directed to a different object or task identified on the riddle or clue they were given. The participant would even have to speak to the patient to receive their next clue or riddle, including a potential score for the scale. Supplies and clues needed were based on tables found in Laerdal’s Simulation Escape Room Workbook (2020).

Each participant was given an 8.5 by 11-inch laminated scale with descriptions of each category of the MORSE Fall Scale on the back. This was a reference for them to utilize while making their way through the escape room. The Morse Fall Scale listed on the front provided each participant with the opportunity to score the standardized patient based on the riddles and clues they were given. They could write their findings on the laminated form with a dry erase marker.

The rules determined by the Education Team were briefed ahead of time, and it was also explained that a moderator would be available in the room to help with questions if necessary. During the post-brief, the participants and moderator discussed the objectives and whether each objective was met, questions were addressed, and the group discussed both personal and team strengths and weaknesses.

Overall, the experience by participants and educators was positive as comments included, “this was a great and different way to learn.” Another said, “(I) would like to do something like this again.” In addition, educators said they learned how to strengthen the education they provide to nurses, and that not all education has to be in a completely controlled situation. Sometimes providing guidance allows for the individuals to critically think and figure out the problems (clues/riddles) on their own. Staff also learned that not all simulation has to be about nursing skills. More often it needs to be about teamwork and team building. This simulation allowed for people from different areas, who do not normally work with one another, to come together and show their strengths. More importantly it allowed nurses to understand that their nursing assistants are a valuable resource when caring for these patients. The nursing assistants are truly the eyes and ears of the nurses, the nurses are the eyes and ears of physicians, and it takes all of them working together to provide the superior care that our Veterans deserve.

Special contribution to this article was by Bonny Athy BSN, RN; Tammy Walton MSN, RN; Krys Lehman MSN, RN; and Natalie Nedza, MSN, RN.


Adams, V., Burger, S., Crawford, K., & Setter. R. (2018). Can you escape? Creating an escape room to facilitate active learning. Journal for Nurses in Professional Development 34(2), p. E1-E5.

Brown, N., Darby, W., & Coronel, H. (2019). An escape room as a simulation teaching strategy. Clinical Simulation in Nursing, 30, p.1-6. DOI NOT FOUND -

Laerdal. (2020, January 24). Simulation Escape Room Workbook. Laerdal.