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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 resulting in electrolyte imbalance, rhabdomyolysis, and hypermetabolic response to succinylcholine and volatile anesthetic agents. • Minutes count when treating the patient experiencing a crisis due to MH to minimize morbidity and avoid cardiac arrest (1) • Patient outcome depends on early identification of MH signs/symptoms and availability of dantrolene (or Ryanodex) for immediate treatment. These drugs and other pertinent supplies for immediate treatment are typically kept in a cart near the operating room (OR) suites. • Patients are frequently anesthetized in locations remote from the OR suites and thereby owing to delays in MH treatment. Analysis / Tests of Change Results Conclusion Assessment of MH preparedness revealed challenges for rapid treatment of the patient experiencing an MH crisis in a remote anesthetizing location. Simulation, collaboration, MH education and system changes resulted in a significant reduction in the time to first dose of dantrolene, meeting MHAUS treatment recommendations and critical for patient outcome. Future directions include similar assessments and implementation of necessary improvements for MH preparedness for all remote anesthetizing locations. Aim Statement Assess MH Preparedness at a remote anesthetizing hospital location to ensure MHAUS guidelines (first dose of dantrolene administration within 10 minutes of MH symptoms) are met. (1) References (1)www.MHAUS.org/ president's blog MARCH 3, 2016 JULY 29, 2016 OCTOBER 6, 2016 NOVEMBER 10, 2016 MH kit arrival ****** 1 minutes 3 minutes 1 minutes 1 st 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) Debriefing Strengths 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 cart arrival *Call put on hold *Elevator delay *Communication breakdown *Delayed cart arrival *Telephone tree failure *MH kit issues (difficult reconstituting dantrolene) *Communication breakdown regarding POT contact 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 communicatio n/teamwork practice *Continue periodic drills *Continue MH education & response training *Continue communication & teamwork practice *Continue periodic drills Analysis / Tests of Change An unannounced MH drill was used to assess hospital preparedness in the Pre/Post Cath Lab located one floor below our OR suites/MH Cart. Strengths and challenges were identified. In collaboration with nursing staff and perioperative technologists (POTs), MH education was introduced, follow-up unannounced drills were used to assess progress and challenges/strengths were addressed until we demonstrated administration of dantrolene ≤ 10 minutes of diagnosis. 0 5 10 15 20 25 30 1st dose of dantrolene (min) 1st dose of dantrolene (min) KIT:1 min KIT:3 min KIT:1 min
