Keywords: simulation-based education; Basic Life Support anaphylactic shock; Kirkpatrick model; RACI approach; non-technical skills; patient safety

Setting:

The practice was implemented in two secondary hospitals in North Macedonia, as a prospective descriptive evaluation study using simulation-based education as the primary training method. The activities took place in clinical training settings, allowing participants to practice both technical procedures and teamwork in a safe, controlled context. The initiative addressed common challenges in emergency care related to unclear role allocation and team coordination.

Target group:

The target group consisted of nurses and other healthcare professionals actively involved in emergency medical care, including those responsible for BLS and the management of life-threatening conditions such as anaphylactic shock

Description of the innovative practice or project:

The innovative practice combined simulation-based education with the structured RACI approach (Responsible, Accountable, Consulted, Informed) to improve role clarity within emergency care teams. Training workshops included a brief theoretical introduction, realistic simulation scenarios for BLS and anaphylactic shock, and facilitated debriefing sessions. The integration of the RACI model supported clear task distribution, improved communication, and strengthened decision-making processes. Training effectiveness was systematically evaluated using the Kirkpatrick model, focusing on participants’ reactions, learning outcomes, and practical results

Evaluation:

Total of 232 participants took part in the program. At reaction level- 94.5% reported that the BLS training met their expectations, and 95.7% rated simulation as the most effective method for improving emergency performance. For anaphylactic shock training, 83.3% reported meeting expectations. At learning level, post-test scores increased by approximately 30% for BLS and 35–40% for anaphylaxis management. The results level- 89.5% reported high confidence in performing BLS with an automated external defibrillator, and 73.5% reported increased readiness to manage anaphylactic shock independently.

Next Steps:

The practice demonstrates strong potential for continuation and scaling to additional healthcare institutions, supporting standardized emergency training programs

Lessons learned:

Simulation-based education combined with RACI-based role allocation enhances technical and non-technical skills, improves teamwork, increases patient safety, and represents a sustainable approach to quality improvement in emergency care.