Clinical Issue: Malignant Hyperthermia (MH) is an inherited disorder of skeletal muscle triggered in susceptible patients that results in hyper metabolism, skeletal muscle damage, hyperthermia, and possibly death. An Operating Room (OR) Registered Nurse (RN) preceptor identified the need for augmented education using hands-on MH crisis simulations. Previous MH education for OR staff included an annual lecture. Because most staff in that OR had not experienced an MH crisis in practice, this simulation was designed to increase staff perceptions of knowledge, skill, and confidence when reacting to an MH crisis. Description of Team: The initial planning team included a simulation lab education facilitator, the RN preceptors from two OR departments, the director of both OR departments, and anesthesiologists. Preparation & Planning: Scenario design and development is an important step in the education process to ensure that learning objectives are met and that the participants have a meaningful learning experience. The MH simulation scenarios were designed and executed based on information from the Malignant Hyperthermia Association of the United States (MHAUS) and the Association of periOperative Registered Nurses (AORN). Learning objectives were established early in the planning process. After that, simulation scenarios were edited by the planning team. The team also competed a practice run of the MH simulation before the first session was offered.
Assessment: A pre and post evaluation was used as an assessment tool. The learners were asked to assess the change in their knowledge and skill level. The learners rated their level of confidence for each learning objective using a 5-point Likert scale, ranging from “Very Low” (score of 1) to “Very High” (score of 5). Implementation: Fifty six learners have participated in an MH simulation during four different sessions. Multidisciplinary participants included the following job roles: surgeon, anesthesiologist, resident, medical student, physician assistant, nurse practitioner, perfusionist, RN, Licensed Practical Nurse, surgical technologist, anesthesia technician (tech), perioperative tech, cardiovascular tech, and clinical associate. Outcome: Data analysis was performed on the self-evaluations using a paired sample t-test. All evaluation scores were statistically significant with a p-value less than 0.001. Learning Objectives with pre-evaluation score and post-evaluation score: Recognizing and assessing for emergent patient deterioration Score increased from 3.25 to 4.16 Intervening appropriately for malignant hyperthermia crisis Score increased from 3.02 to 4.25 Utilizing resources available for management of emergent situations Score increased from 3.32 to 4.34 Prioritizing patient care interventions in emergent situations Score increased from 3.30 to 4.32 Implications for Perioperative Nursing: Simulation education can be used to increase the knowledge, skills, and confidence of OR staff during emergency events. Simulation can provide a place for learners to practice skills and receive instruction in a safe environment that poses no risk to patients.
Co-Authors: Karen Kline, Beth Bond, Michael Saccocci, Ali Kazemi, Cheryl Moses