Malignant hyperthermia is an uncommon disorder that presents in an ambulatory surgery center utilizing general anesthesia. Preparation for management of this condition needs to be a significant part of ASC patient safety protocols, and this preparation needs to be proper and complete. Blue Chip Surgical Partners Vice President of Operations Regina E. Dolsen, RN, BSN, MA, suggests ASCs address the following 12 questions to help accomplish this objective.
1. Do you have an MH cart or kit, and is it properly stocked? This should contain the required and non-expired drugs (dantolene), equipment, supplies and forms. It should be immediately accessible to all operating rooms.
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2. Do you have organizational protocols for treating patients with known history of MH? Has your ASC determined whether you will perform procedures on a patient with a known history of MH? "You should have a policy stating this," says Ms. Dolsen. "You should also have, as part of your pre-assessment, questions you will ask of all of your patients to try to learn to any MR history they might have."
3. Do you have a point person that is responsible for your MH preparation? This includes maintaining equipment, supplies and ensuring training. "It can be the safety officer, but sometimes other people will own that particular activity and it becomes a part of their role to keep things current," Ms. Dolsen says. "They go regularly onto the MHAUS (Malignant Hyperthermia Association of the United States) website to see what's new and changed and they're responsible for the checking and maintaining the cart. You just want someone to own that cart and that role within the facility so they're the go to person for questions, the person who looks for the resources, update guidelines, finds new tools, etc."
4. How do you prepare for an MH event? "It should be a hands-on drill," she says. "It should include the mixing of the dantrolene and physically preparing it. You literally conduct the drill. You walk through the steps, you don't just do it on paper. That's really the best way to prepare."
5. What is the education/training program for new employees and annual training for existing employees? This ties in with the necessary drilling, Ms. Dolsen says. "Make sure you keep your training tools updated and provide time for questions and answers rather than just sit your staff down in front of a machine to watch an educational video," she says. "There are a lot of self-learning modules that cover MH. They're good but make sure you provide time for questions and answers and remember that this doesn't replace the hands-on drill. That's critical."
6. Do you have a role for your consulting pharmacist in the training/setting up or keeping protocols current? Ms. Dolsen says she has seen some facilities have their consulting pharmacist participate in the annual education on MH. "People don't tend to think about using their consulting pharmacist," she says. "He can be a good resource, depending on his skill set, to help you with education and training. It's also a good role for him to review the cart as part of his risk assessment when he's in a facility covering all of the meds. That can be helpful."
7. What is the role of anesthesia? Has your ASC clearly defined the responsibility of anesthesia? "Every facility manages it different," Ms. Dolsen says. "Some anesthesiologists take a big role in this and actually do the training. Even if training falls to the consulting pharmacists or clinical nursing, you still need to have the role of anesthesia defined because in the event MH occurs, they usual control how the event is managed and become the team leader."
8. Do you have visual aides on the cart or in a designated area which reviews the steps for recognizing the situation, and providing immediate treatment? "There are resources out there, primarily from MHAUS, and they're very effective," says Ms. Dolsen. "MH is something we hope to never see in our lifetime but when it does occur, we don't have time to open the policy book. Those visuals are very well done and can play a vital role in saving a person's life."
9. Do you know about the MH Hotline? Described as the "most notable and important of MHAUS' services," the Hotline provides medical professionals with access to MH experts who can be reached for help with MH crises around the clock. The number: (800) MH-HYPER ((800) 644-9737).
10. Do you have concise forms to use during an event? "It's a good idea to continually review and update your documentation records to chart during an event so they're simple to use and they're clear," Ms. Dolsen says. "MH is an emergency event and people are usually not reviewing that form on a regular basis. It's worth including as part of your drills actually documenting on the form as that will help tell you whether your form is useful or not. We've run into convoluted forms that, in an event, do not work."
11. Do you have specific transfer protocols? "They really should take it beyond their normal transfer agreement protocol," says Ms. Dolsen. See "7 Best Practices for an Effective Malignant Hyperthermia Transfer Plan" to learn more.
12. What methods are in place for cost-effective management of supplies and medications? Oftentimes since the MH cart is not used and the event is not seen, both fortunate circumstances, the dantrolene expires. You should consider using these expired medications as part of your for training drills, says Ms. Dolsen. She also advises discussing with your vendors cost-effective ways to acquire items you need for MH hands-on training with the understanding that these items are not for actual patient use.
Learn more about Blue Chip Surgical Partners.
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