Malignant Hyperthermia Training for Time-Strapped Facilities

Escape rooms, interdisciplinary drills and independent online courses can help providers learn to respond to this serious but rare condition.

It wasn’t until the caregiver team was debriefing that Connie Schwendeman, MSN, RN, CPAN, NPD-BC, began to relax. Ms. Schwendeman, a corporate learning consultant at Orlando Health, had just witnessed the team respond to a simulated case of malignant hyperthermia (MH) in a recently opened freestanding emergency department.

Malignant hyperthermia is a rare sudden-onset condition, but a very serious one that all surgical facilities must be ready to treat. That’s why efficient training is so important — and that’s exactly why Ms. Schwendeman was present for the emergency department team exercise. An expert in experiential learning and a board member for the Malignant Hyperthermia Association of the United States (MHAUS), Ms. Schwendeman had the memorable experience of watching the new team bond over an MH simulation.

“You do have those feelings of anxiety or urgency, and that shows that we did a good job creating the scenario, because if people don’t feel that, then they’re not immersed in the experience,” says Ms. Schwendeman.

Simulations can be an exciting and impactful way for teams to learn together and, coupled with debriefing sessions, provide space for greater understanding of rare crises. Evidence also suggests that immersive experiences enhance learning and knowledge retention, notes Ms. Schwendeman. Since not all caregivers may experience a true case of malignant hyperthermia during their careers, such scenarios help connect them with the right training and resources. Indeed, a range of memorable techniques are available to teach teams of all sizes, and all budgets, how to recognize and respond to MH.

Infrequent, but important to identify

MH is a serious reaction to certain anesthesia drugs, causing high body temperature, muscle stiffness, a fast heartbeat and more. Without quick treatment, it can be fatal. Spotted early and treated properly, however, full recovery is possible.

The muscle relaxant succinylcholine and most inhalation anesthetics, excluding nitrous oxide, can trigger MH. Additionally, rare cases tie MH to intense exercise, heat, viral illness or statin meds for cholesterol.

Being able to identify MH is vital, as is finding out if a patient may be predisposed to the condition. Before surgery, healthcare providers should consistently inquire about any past reactions to anesthesia, as malignant hyperthermia risk often involves an inherited gene. Occasionally, random genetic changes can also contribute to the risk. Sometimes, geographic region plays a part in the likelihood of malignant hyperthermia, due to concentrations of MH-susceptible families. It’s therefore important to gather information on family history, ask the question multiple times and in various ways, and be familiar with a facility’s service area when possible.

Accessing available resources

While malignant hyperthermia is a rare occurrence, staff must still be ready to act in an instant when there’s an MH event. That’s why it is crucial to regularly train your staff. Generally, the following key elements should be covered in a training curriculum:

• recognition of initial symptoms;
• assigned and distinct responsibilities;
• familiarity with emergency equipment;
• implementation of emergency response procedures; and
• application of suitable treatment measures.

As an independent perioperative consultant, Deborah Spratt, MPA, BSN, RN, CNOR, NEA-BC, CHL, is often tasked with helping teams with emergency preparedness. Her best advice for teams who need to prepare for an MH event: Run annual, interdisciplinary drills for crisis situations. “It’s so important to do multidisciplinary training, and I think that is a missing piece,” says Ms. Spratt. “Many times people will say, ‘Well, nursing knows what they’re doing, so let them do it.’ That’s just not enough.”

While on-site for a recent training, one of Ms. Spratt’s first steps to get everyone on the same page was to order updated signage from MHAUS, which is recognized as the leading nonprofit organization promoting MH care and understanding. Materials available from MHAUS include step-by-step response instructions and a go-to list of supplies recommended to stock a MH response cart.

Like any other crash cart, the MH cart needs to be checked routinely, says Ms. Spratt. So, with the MHAUS recommendations leading the way, she assisted the facility in identifying what should be on the cart and then in creating an additional one. “In a small place, the middle of the night is not the time for someone to have to go two floors up or down to go find the malignant hyperthermia cart,” says Ms. Spratt.

Calling the MHAUS hotline

FULLY STOCKED Your MH crash cart should be checked routinely to confirm it’s full of all items recommended by the Malignant Hyperthermia Association of the United States.

Ms. Spratt encourages the facilities she works with to rely on resources available through MHAUS to prepare for a potential crisis and treat a case of malignant hyperthermia.

The MH Hotline, established in 1982 to provide real-time advice to professionals encountering a potential crisis, is free to call in an emergency. Any caller requesting consultant help will be connected to an MH expert by dialing 1-800-644-9737.

Having a plan for clear and concise communication, as well as dedicated assigned roles, is always helpful. To that end, MHAUS offers a mock drill call, where a team can, for a small fee, practice calling the MH Hotline. This must be scheduled in advance, but further helps teams prepare and adds a realistic element to training.

When it comes down to reacting to the real deal, roles must be clear. “Somebody needs to be in charge and then assignments need to be made,” says Ms. Spratt. “Someone should be tasked to call MHAUS and put them on the speakerphone in the OR, so that they are an immediate resource for everything that’s going on. That is exactly what they’re there for 24/7.”

While repeated training continues to be a tried-and-true method to assist providers in knowledge application and skills retention, there is also room to incorporate innovative training methods and technologies.

Fresh training options

Interdisciplinary simulations enable caregivers at ChristianaCare in Newark, Del., to utilize a team-based approach to work through a scenario like a malignant hyperthermia crisis in an environment close to reality, says Ashley Oncay, MSN, RN, CNOR, NPD-BC, a nursing professional development team leader at ChristianaCare.

“We are curious and continuously look for ways to innovate. To that end, we are exploring training methods such as virtual reality and gaming to expedite the learning process for our caregivers,” says Ms. Oncay.

In an attempt to prevent drill fatigue for caregivers and facilitators, ChristianaCare spaces its drills throughout the year: January is for malignant hyperthermia; March for fire drills; September for difficult airway drills; and November for code blue drills. Prime vacation periods are avoided. This schedule helps to optimize the overall effectiveness of the education plan.

Since MH is such a rare condition, adds Ms. Oncay, the annual drills serve as instruction for new staff and a refresher for more experienced caregivers. She also emphasizes the importance of making the drills interdisciplinary, especially to break down communication barriers among caregivers. ChristianaCare is seeing results: Staff have reported increased comfort levels in communication among the procedural team, as well as other favorable outcomes.

“Our caregivers have reported increased efficiency with recognizing an emergency and how to activate an emergency response. Outcomes in medical emergencies are directly related to timely recognition of the emergency in order to implement the correct treatment,” says Ms. Oncay. “Our drills give staff the opportunity to practice recognition and treatment of different emergencies while allowing space for discussion and questions in order to increase caregiver comfort.”

Creating an MH escape room

Combining technology for an engaging learning experience creates myriad opportunities for effective training. Ms. Schwendeman references low- and high-fidelity mannequins and task trainers as tools that can help with simulation training.

However, there are other ways to create interactive experiences, and these may be sized to fit individual training or group settings.

Ms. Schwendeman and a co-worker are currently in the process of developing interactive malignant hypothermia education that caregivers could complete online. The content will include a voiceover presentation with embedded questions for participants to answer through drag-and-drop or fill-in-the-blank activities. The aim is to keep the audience actively involved, shifting from general information to specific treatment aspects, and to prevent disengagement during the session.

For a group setting, Ms. Schwendeman would like to create a malignant hyperthermia training escape room, where various puzzles and activities help drive home available resources and MH identification, among other topics.

In addition to preparing caregivers for a potential malignant hyperthermia case, these training sessions also encourage teamwork and improve communication — which ultimately could make a big difference in responding to an MH call.

“No one has absolute knowledge, and no one is above going to another person to say, ‘Hey, what do you think about this?’ because, as we know with MH, it doesn’t always look the same from patient to patient,” says Ms. Schwendeman. OSM