kundu simulation, collaboration and education...
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Simulation, Education and Collaboration Improve Practice Parameters for Malignant Hyperthermia Preparedness in a remote Anesthetizing Setting: Egleston Cardiac Pre/Post Catheterization Lab
Tripali Kundu, MD; Darlene Mashman, MD; Christina Dooley, BSN, RN
Introduction• Malignant Hyperthermia (MH) is a life
threatening pharmacogenetic disorder resultingin electrolyte imbalance, rhabdomyolysis, andhypermetabolic response to succinylcholine andvolatile anesthetic agents.
• Minutes count when treating the patientexperiencing a crisis due to MH to minimizemorbidity and avoid cardiac arrest (1)
• Patient outcome depends on early identificationof MH signs/symptoms and availability ofdantrolene (or Ryanodex) for immediatetreatment. These drugs and other pertinentsupplies for immediate treatment are typicallykept in a cart near the operating room (OR)
suites.• Patients are frequently anesthetized in locations
remote from the OR suites and thereby owing todelays in MH treatment.
Analysis / Tests of Change Results
ConclusionAssessment of MH preparedness revealed
challenges for rapid treatment of the patientexperiencing an MH crisis in a remoteanesthetizing location. Simulation,collaboration, MH education and systemchanges resulted in a significant reduction inthe time to first dose of dantrolene, meetingMHAUS treatment recommendations andcritical for patient outcome. Future directionsinclude similar assessments andimplementation of necessary improvements forMH preparedness for all remote anesthetizinglocations.
Aim StatementAssess MH Preparedness at a remote
anesthetizing hospital location to ensure MHAUSguidelines (first dose of dantroleneadministration within 10 minutes of MHsymptoms) are met. (1)
References(1)www.MHAUS.org/ president's blog
MARCH3,2016
JULY29,2016
OCTOBER6,2016
NOVEMBER 10, 2016
MH kit arrival ****** 1 minutes 3 minutes 1 minutes
1st dose of dantrolene 2.5mg/kg; 20kg patient
26 minutes 16 minutes 20 minutes 8 minutes
MH cart arrival 13 minutes 35 minutes 23 minutes 10 min(4 calls to designated POT
phone)
DebriefingStrengths Staff eagerness to learn about MH & treatment protocol in order to improve response times and
patient care.
Challenges*Communication
breakdown
*Delayed cart arrival
*POT unsure of cath lab location
*Elevator delay
*Communication breakdown
*Delayed cartarrival
*Call put on hold
*Elevator delay
*Communication breakdown
*Delayed cart arrival
*Telephone tree failure
*MH kit issues(difficult reconstituting
dantrolene)
*Communicationbreakdownregarding POTcontact number
Proposed Solutions *Closed loop
communication
*MH starter kits
*MH education
*Closed loop communication
*POT daily assignment sheet at cath lab front desk
*Starter kit beneficial
*Continued MH education
*Designated POT to cath lab area
*Continue MH education & response training
*Continue communication/teamwork practice
*Continue periodic drills
*Continue MH education & response training
*Continuecommunication & teamwork practice
*Continue periodic drills
Analysis / Tests of ChangeAn unannounced MH drill was used to assesshospital preparedness in the Pre/Post Cath Lablocated one floor below our OR suites/MH Cart.Strengths and challenges were identified. Incollaboration with nursing staff and perioperativetechnologists (POTs), MH education wasintroduced, follow-up unannounced drills were usedto assess progress and challenges/strengths wereaddressed until we demonstrated administration ofdantrolene ≤ 10 minutes of diagnosis.
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1st dose of dantrolene (min)
1st dose of dantrolene (min)
KIT:
1 m
in
KIT:
3 m
in
KIT:
1 m
in