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Studies have shown that most critical events that occur in the post-anesthesia care unit (PACU), including cardiac arrests, are preventable and respiratory in origin. Admission to the PACU necessitates transfer of care from anesthesiology staff to PACU nurses. The aim of the study is to assess a) feasibility in implementing an in-situ curriculum for PACU nurses to manage common pediatric emergencies, b) the effectiveness of the curriculum in improving self-confidence of the PACU nurses in performing essential skills c) nurses'' perception of such an offering.This was a single center curricular evaluation study. Anonymous surveys were used to assess curriculum effectiveness by comparing self-reported confidence in the execution of key technical skills and application of knowledge in a real clinical environment at three time points: baseline, immediately post-simulation, and 3 months later.Of 50 PACU nurses, 80%, 98% and 58% responded to the targeted needs assessment, post-simulation and follow up (at 3 months) survey respectively. Self-reported confidence levels for most of the essential skills were significantly increased immediately after simulation and at 3 months. Most of the participants responded that the simulation training helped them improve care of hypoxic (83%) and hypotensive (62%) patients in the PACU.Implementation of in situ curriculum for PACU nurses was feasible. The self-reported confidence in performing essential skills increased significantly and the nurses could apply these skills in real clinical environment.Interprofessional simulation should be implemented in all high risk units to optimize safety of children.

Effectively communicating patient safety concerns in the operating theatre is crucial, but novice trainees often struggle to develop effective speaking up behaviour. Our primary objective was to test whether repeated simulation-based practice helps trainees speak up about patient management concerns. We also tested the effect of an additional didactic intervention over standard simulation education.This prospective observational study with a nested double-blind, randomised controlled component took place during a week-long simulation boot camp. Participants were randomised to receive simulation education (SE), or simulation education plus a didactic session on speaking up behaviour (SE+). Outcome measures were: changes in intrapersonal factors for speaking up (self-efficacy, social outcome expectations, and assertiveness), and speaking up performance during four simulated scenarios. Participants self-reported intrapersonal factors and blinded observers scored speaking up behaviour. Cognitive burden for each simulation was also measured using the National Aeronautics and Space Administration Task Load Index. Mixed-design analysis of variance was used to analyse scores.Twenty-two participants (11 per group) were included. There was no significant interaction between group and time for any outcome measure. There was a main effect for time for self-efficacy (P0.001); for social outcome expectations (P0.001); for assertive attitude (P=0.003); and for speaking up scores (P=0.001). The SE+ group's assertive attitude scores increased at follow-up whereas the SE group reverted to near baseline scores (P=0.025).In novice anaesthesia trainees, intrapersonal factors and communication performance benefit from repeated simulation training. Focused teaching may help trainees develop assertive behaviours.