The FIRST2ACT simulation program improves nursing practice in a rural Australian hospital


  • Competing interests: The authors declare they have no competing interests.

Dr Leigh Kinsman, School of Rural Health, Monash University, PO Box 666 Bendigo, Victoria, 3552, Australia. Email:


Objective:  To measure the impact of the Feedback Incorporating Review and Simulation Techniques to Act on Clinical Trends (FIRST2ACT) simulation program on nursing observations and practice relevant to patient deterioration in a rural Australian hospital.

Design:  Interrupted time series analysis.

Setting:  A rural Australian hospital.

Participants:  All registered nurses (Division 1) employed on an acute medical/surgical ward.

Intervention:  The FIRST2ACT simulation program.

Outcome measures:  Appropriate frequency of a range of observations and administration of oxygen therapy.

Results:  Thirty-four nurses participated (83% of eligible nurses) in the FIRST2ACT program, and 258 records were audited before the program and 242 records after. There were statistically significant reductions in less than satisfactory frequency of observations (P = 0.009) and pain score charting (P = 0.003). There was no measurable improvement in the administration of oxygen therapy (P = 0.143), while the incidence of inappropriate nursing practice for other measures both before and after the intervention was too low to warrant analysis.

Conclusion:  FIRST2ACT was associated with measurable improvements in nursing practice.