Despite in-depth effort to decrease in-hospital clinical deterioration, patients continue to suffer adverse events due to health care teams’ failure to recognize and respond timely to subtle changes in patients worsening clinical status. Prevention of in-hospital cardiac arrest is imperative, as the survival-to-discharge rate remains at a low 10-15% nationally. Synthesis of the evidence identified moderate-level evidence suggesting rapid response systems (RRS), early warning scores (EWS), and accurate vital signs (VS) monitoring have demonstrated the strongest correlation with improved patient outcomes such as unplanned ICU admission, adverse events, and mortality. This evidence-based quality improvement project sought to identify a system for early recognition of deterioration through the implementation of a simulation activity focused on proper vital signs assessment and documentation techniques on two progressive care units. Triggers to the RRS from the EWS increased an average of 42% in study units during the post-implementation phase. Vital signs comprise most of the algorithm to trigger the warning for patients showing signs of deterioration. During simulation sessions, it was clear there was a lack of awareness of the importance of respiratory rate in the deterioration process. Additionally, wide variation existed in key elements of obtaining respiratory rates, such as patient positioning and length of time to measure respirations. Simulation activities demonstrated that while we have learned to use technology to assist in evaluating patients for deterioration, the system cannot be successful without skilled techniques performed by professionals in obtaining accurate vital signs.