233 - Improving OR Staff Malignant Hyperthermia Response Through Simulation Training
Description: Malignant hyperthermia (MH) is a potentially fatal, inherited disorder usually associated with the administration of certain general anesthetics and/or the drug succinylcholine. The incidence of MH in adults is approximately 1 in 100,000 surgeries. Severe complications such as cardiac arrest, brain damage, internal bleeding or failure of other body systems may occur if the crisis is not treated promptly. Didactic education traditionally involves lectures and memorization of material. For low-volume high-risk emergency situations such as MH, traditional learning does not allow the learner hands-on practice, nor does it allow a team to practice clinical procedures, communication, or teamwork in a realistic, high-tension scenario. MH simulation training incorporates interdisciplinary collaboration between OR RNs, facility Simulation Coordinator, anesthesia providers, pharmacy, anesthesia technicians, circulating RNs, and surgical technicians. A PowerPoint presentation was created. The simulation was developed in conjunction with the facility Simulation Coordinator, the Chief of Anesthesia and the CRNA in charge of the MH cart. The presentation was presented to OR staff (RNs and surgical technicians). The MH cart was also shown and discussed following the presentation. Sixty days after the PowerPoint presentation, the unannounced simulation training was conducted. Actors portrayed the patient, the anesthesia provider, the surgeon, the resident, and the MH Hotline Operator. The patient was prepared with a simulated IV, a patient gown, patient socks, and sequential compression devices and was draped on the operating room table with a simulated ET tube and Bair Hugger upper body warming blanket applied. The MH cart was stocked with simulated vials of dantrolene created utilizing supplies from pharmacy and the facility Simulation Center that can be reconstituted and administered. Four OR staff were randomly selected to portray the circulating RNs, Surgical Technician, and a runner. The remaining staff were observers. The team was briefed outside the OR room regarding the case in progress. The team assumed their respective roles and entered the OR where the simulation began with the MH crisis developing a few minutes into the scenario. The objectives must be met by the staff members before the simulation ends.Although OR staff were initially hesitant to be “put on the spot” during the simulation, they excelled under pressure, met the objectives, and administered dantrolene within an average of 8.6 minutes from the onset of symptoms. 100% of participants that completed the evaluation “strongly agreed” that the simulation will be applied to their clinical practice. Simulation training is an effective method to improve clinical skills, enhance teamwork, practice technical skills, make mistakes, and test systems without risking patient harm. Low volume, high risk situations such as MH crisis are ideal topics for simulation training.