297 - Inter-professional Approach to Malignant Hyperthermia Training
Description: Description of Team This involved a multidisciplinary team including, the anesthesiologist, CRNA, surgeon, resident, RN Circulator, surgical technician, and anesthesia technician. Every campus OR was represented five surgical areas including, Children’s Hospital, University Hospital, Outpatient Surgery Center, East Campus, and Surgical Hospital. Preparation and Planning The incidence of Malignant Hyperthermia (MH) reactions ranges from 1:15,000 anesthetics in children and adolescents and 1:50,000 to 1:150,000 anesthetics in adults. Early diagnosis and improved intervention have decreased the reported mortality of MH. The goal was to prepare the perioperative staff with the tools they need to competently and confidently manage the patient with a team approach. The CHOR Clinical Educator and CRNA Clinical Educator collaborated on ideas and developed a MH video script and Scribe Worksheet. This involved researching AORN Guidelines & Malignant Hyperthermia Association of the United States (MHAUS) guidelines. Next, a video was created using a high-fidelity mannequin during a day in an empty OR. Loma Linda University (LLU) Advancement Films assisted with editing. Assessment Past drills identified a need for MH drills involving a multidisciplinary approach. It was challenging to get all team members involved including anesthesia and surgery providers. A method of documentation was found to be needed to record MH events as current documentation and guidance was inconsistent. Implementation A Malignant Hyperthermia Crisis was simulated in the operating room including all perioperative staff. The video was shown at a Joint Staff meeting including all perioperative staff from all campuses. This video was set up to be interactive as the staff watched the video and interactively scribed the MH crisis event. The staff saw their own team members’ role-model “How to handle a Malignant Hyperthermia Crisis,” utilizing the Team STEPPS communication tool, such as Call out, Read Back, and Close Loop Communication. A pre-survey and post-survey was completed by staff prior to watching the video and at 8 months. Outcome After implementing the simulated video and new scribe sheet, the mean MH knowledge scores of education, self-confidence and competence levels increased at the eight-month post survey than pre-survey scores. Education knowledge increased for OR nurses from 76% to 85%. The video provided a visual and interactive training and increased competence in the OR nurses role by 100 % and increased competence by 88%. Implications for Perioperative Nursing Inter-professional simulation training increased the staff’s knowledge and confidence to manage similar real-life scenarios. The MH Crisis simulated video provided visual and interactive training increasing staff confidence and competence in communicating with team members to be better prepared to handle real-life situations in the future.