Date of this Version

11-2024

Document Type

DNP Project

Rights

default

Abstract

Background

Malignant hyperthermia (MH) is a life-threatening hypermetabolic condition triggered by volatile anesthetic gases and succinylcholine, causing excessive calcium release and muscle contraction. Genetic predisposition is marked by autosomal dominant inheritance in RYR1 and CACNA1S genes. Symptoms include increased end-tidal CO2, hyperthermia, tachycardia, and dark urine and can lead to severe complications and death. While MH inheritance is rare (1 in 100,000), genetic susceptibility is more common (1 in 2,000 to 1 in 3,000). Timely recognition is challenging due to varied symptom onset and masked symptoms. Simulation-based team training (SBTT) enhances clinical skills and teamwork, with semiannual MH drills recommended. The American Association of Nurse Anesthesiology (ANAA) suggests ongoing competency education and crisis team training through simulation to improve MH recognition and management, and patient outcomes.

Method

This was a quasi-experimental project with a pretest and posttest design. One benefit of using a pretest and posttest study involves the clear sequencing of the research process. It involves assessing a dependent variable (such as knowledge or attitude) before and after introducing an independent variable (like training or an informational session). While this resembles a traditional experimental design, it leans towards quasi- experimental methods because the participants typically are not randomly assigned. As a result, this design also aligns with correlation. Due to its quasi-experimental nature, it is challenging to establish direct causality in the outcomes; instead, connections between interventions and outcomes are inferred as associations.

Results

In a pre-survey of 14 participants, 71% correctly identified Malignant Hyperthermia Association of the United States (MHAUS) as the organization responsible for MH management, and high awareness of MH signs and symptoms was demonstrated, with 93% identifying muscle contraction, 100% tachycardia, and 93% masseter rigidity. Post-survey results showed improvements, with 92% correctly identifying MHAUS and similar high recognition of symptoms. Confidence in managing MH increased, with 77% strongly agreeing they could recognize symptoms and 85% strongly agreeing they knew the steps to take if a patient exhibited MH symptoms. All participants believed simulation training was more effective than web-based training in improving their ability to recognize and treat MH.

Discussion

This quality improvement project demonstrated significant improvements in knowledge, confidence, and preparedness in recognizing and managing MH among anesthesia providers. Key findings include increased correct responses regarding MH signs, symptoms, and treatments post-training, with 92% correctly identifying MHAUS and 100% identifying masseter rigidity. Confidence in recognizing MH signs rose from 71% to 77%, and all participants believed simulation training was more effective than web-based training. The study highlighted the benefit of simulation training, particularly for new graduates, in enhancing clinical competence and preparedness. These results align with other research indicating the effectiveness of high-fidelity simulation in improving clinical skills and knowledge.

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