My organization onboards new hires each week, and it has become clear that new hires crave interactive, fun, and engaging ways to learn.

After our nursing professional development practitioners (NPDPs) identified learning gaps related to patient safety—utilizing environmental scanning and the “inputs” portion of the Nursing Professional Development Practice Model—our team decided to dive into gamification to engage our learners. Gamification has proven invaluable in education settings for years, having been shown to improve concentration, creativity, memory, engagement, and so much more (Latta, 2024).

This inspired us to invent our first escape room in 2020, when the TV show Stranger Things was all the rage. Everyone was watching it. Utilizing the show as the theme, we created an escape room educational activity that helps staff understand the importance of patient safety and meeting organizational goals. This room was used in nursing orientation and yearly competencies. After three months of utilizing our Stranger Things-themed escape room, falls at our hospital decreased by 20%.

Using this escape room as an example, readers can download a step-by-step guide to building their own escape room from the ground up.

Expanding the Impact: Another Escape Room Example

When our NPD practitioners identified another knowledge gap—we were not meeting all of the elements of our sepsis protocol consistently—we realized we needed education to address auditory, visual, and kinesthetic learning. We decided the escape room was perfect for this. The following is our model for creating this escape room. Please feel free to mimic this or the Stranger Things format for your own purposes as needed.

Step 1: Solving a Puzzle

At this stage, the escape room facilitator reads:

• The doors are locked, and the clock has chimed, but you must move quickly because your mystery is timed. The first clue you seek has interlocking pieces, put it together to see what it teaches.

We created a 48-piece puzzle online. You can create your image on a PowerPoint slide and upload the image on the website. The images on the puzzle lead to the infection. Once the team finishes the puzzle, they must locate the clue in the puzzle to unlock a first lock. We used the last four digits to our sepsis hotline as the password.

Step 2: Inside the First Lock Box

The box has random numbered items—some cause infection and some do not (foley catheter, picc line, infected leg wound picture, sock, toothbrush, oxygen tubing). Once the team identifies the items that can lead to an infection, the facilitator then reads the next clue:

• The mystery items you have found lead you down the path to infection. How you decide to arrange them will determine the correct direction. I’m sure your team is thinking “What do I do or how will I know,” but rest assured you will be right if you assess from head to toe.

The images with infection will be numbered to open the next lock box. The team must arrange them from head to toe to put the numbers in correct order.

Step 3: Inside the Second Lock Box

A patient scenario leads the learners down the path to sepsis. They are provided a copy of the sepsis protocol. The team must then identify which of the patients’ vital signs meet sepsis criteria. Two abnormal vital signs will open the next lock.

The next clue reads:

•  The clue you seek is crystal clear. The symptoms add up so do not fear. How many do you need to access the box…the abnormal ones are sure to unlatch the lock.

We chose heart rate of 110 and respirations of 26 as the lock number.

Step 4: Inside the Third Lock Box

This box holds the items that must be completed for the sepsis protocol (fluids, blood culture bottle, lactic acid lab tube, urine culture container, antibiotics, oxygen tubing, a copy of the Sepsis order protocol) and a Davinci Cryptex lock box. The facilitator has the team remove all of the items from the box on a table and reads the last clue below. All items have individual letters on them that spell the word “sepsis”. The team’s goal is to follow the written protocol order set and place the items in the order in which they are to be administered for a septic patient.

The facilitator then reads the last clue:

• To escape the room, you must crack the code. The magical word leads you down the right road. The tools in the box will help you find all the letters, put them in order to see what really matters.

The protocol items spell “sepsis” when placed in correct administration order. Once the team has the items in order, the facilitator will ask the team if they notice anything about the items in front of them (hinting to the letters on the items). This will help the team recognize the word is “sepsis.” The Davinci Cryptex code word is “sepsis.” This opens the Cryptex, and there is one final key.

Step 5: Inside the Fifth Box

Once opened, learners find a note that reads: “Congratulations you have escaped from sepsis!”

Lastly, our team facilitator hands out badge cards with the steps to sepsis and there is candy in the box for the participants. We debrief about sepsis and its importance and answer questions.

Our sepsis escape room is a hit and has been mobilized and taken to units to be used by NPDPs as a roaming educational opportunity. The beauty of this escape room is it can be executed in a break room, at a nurses’ station, or in an empty patient room, and it only takes 11 minutes to complete. We were able to increase our compliance ratio with our sepsis order set to 96% ensuring that all items of the order set were completed within the time limits. We were previously at 87%. The education helped staff understand the importance of when labs and cultures were to be collected and the time antibiotics were to be given.

Escape Rooms: A Value-Add

After implementing our escape rooms, we sent out a post orientation survey asking new hires about their experience in our orientation. Our orientation includes lectures, simulations, computer training, and two escape rooms. Over 1876 people have taken the survey and 96% rate the escape rooms as their favorite resource for learning. Many comment on how it encourages collaboration and the development of social skills. After implementing these two rooms, I have been asked to create several other escape rooms for NPDPs to use on their units or during their competencies to help foster a better learning experience. Escape rooms can generate intrinsic motivation in the players. Other advantages include favoring learning, improving attitudes and social skills, and involving students with the subject and teamwork. Ultimately, escape rooms could provide an exciting engagement for higher education programs (Manzano-León et al., 2021).

References

• Latta, N. (n.d.). Educational Gaming: The Future of Health Care. Http://Nursingworld.org. Retrieved August 26, 2024, from https://www.nursingworld.org/practice-policy/innovation/blog/educational-gaming-the-future-of-health-care/
• Manzano-León, A., Rodríguez-Ferrer, J. M., Aguilar-Parra, J. M., Martínez Martínez, A. M., Luque de la Rosa, A., Salguero García, D., & Fernández Campoy, J. M. (2021). Escape Rooms as a Learning Strategy for Special Education Master's Degree Students. International journal of environmental research and public health, 18(14), 7304. https://doi.org/10.3390/ijerph1814730