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Kay Redelings, RN Victor Monrreal, PharmD Mary Abbott, MSN, RN, CCRN

Malignant Hyperthermia (MH) Simulation-based Training in the Electroconvulsive Therapy (ECT) Department. Kay Redelings, RN Victor Monrreal, PharmD Mary Abbott, MSN, RN, CCRN. Learning Objectives. Participants will understand: Electroconvulsive Therapy (ECT)

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Kay Redelings, RN Victor Monrreal, PharmD Mary Abbott, MSN, RN, CCRN

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  1. Malignant Hyperthermia (MH) Simulation-based Training in the Electroconvulsive Therapy (ECT) Department Kay Redelings, RN Victor Monrreal, PharmD Mary Abbott, MSN, RN, CCRN

  2. Learning Objectives • Participants will understand: Electroconvulsive Therapy (ECT) Malignant Hyperthermia (MH) Cognitive Load in the context of Simulation Training Key components in the design of Simulation Training

  3. Electroconvulsive Therapy • ECT resembles cardioversion • In the same way that cardioversion resents the electrical activity of the heart, ECT helps to reset the neural activity in the brain. • The electrical stimulation provided by ECT promotes nerve-cell activity releases chemicals in the brain and helps restore normal functioning.

  4. Malignant Hyperthermia • Inherited and life-threatening disorder of the skeletal muscle • Triggered in most instances by certain general anesthetics and/or succinylcholine

  5. Malignant Hyperthermia • 2016 - Identified the need to establish a Malignant Hyperthermia (MH) protocol. • 2017 - General education about MH and MH protocol to ECT staff. • Staff did not feel confident enough to manage an actual MH crisis. • Worried that if an actual event did occur, they would not be able to provide optimum care to the patient.

  6. Simulation-based Training • Collaborative Cognitive Load Theory (Kirschner & Sweller, 2018) - What is cognitive load? - Why does cognitive load matter? - How can educators mitigate extraneous load? - What are schemas? - What is collaborative learning and why is it effective? - Why is developing collective working memory important? - Why simulation-based training?

  7. Mitigating Intrinsic load • Objective: reduce the load on working (short-term) memory • ECT-specific learning module • Introduce Quiz • Pre-procedure screening • Badge Cards • - “ABCD’s of MH” • - Early clinical S&S • ECT-specific competency

  8. Outcomes Compared to the Nursing - Malignant Hyperthermia (MH) Learning Center module (original version for acute care), rate the overall effectiveness of the SMV ECT Malignant Hyperthermia (MH) Learning Center module (ECT specific version) provided to you in 2018, to educate you about malignant hyperthermia, clinical implications and treatment in your practice setting.

  9. Outcomes Compare your level of confidence from the malignant hyperthermia education you received in the past with the recent 2018 ECT MH Mock Event simulation to identify the early signs and symptoms of malignant hyperthermia.

  10. Mitigating Extraneous load • Objective: organize elements into schemas to enhance long-term memory/recall 1. Pharmaceutical Management - Reconstitute dantrolene & calculate appropriate dose - Provide pre-filled medication syringes whenever possible - Visualize and place hands on other medications in the kit Infusion & IV Push Management - Hands on practice with simulated “cooled” NS infusion - Hands on practice drawing up and pushing dantrolene - Visualizing the need for two PIV sites Process for Cooling the Patient - Hands on role play with actual supplies needed to make ice bags - Walk through pathway and process to make ice bags Emphasis is on Teamwork - Utilization of Role Task Cards informs learners “what to do” at a glance - Resource to enhance organization and collaboration during a highly complex scenario

  11. Outcomes Compare your level of confidence from the malignant hyperthermia education you received in the past with the recent 2018 ECT MH Mock Event simulation to reconstitute and administer dantrolenevia IV push.

  12. Outcomes Compare your level of confidence from the malignant hyperthermia education you received in the past with the recent 2018 ECT MH Mock Event simulation to infuse cooled normal saline through a second peripheral IV.

  13. Outcomes Compare your level of confidence from the malignant hyperthermia education you received in the past with the recent 2018 ECT MH Mock Event simulation to obtain ice, make ice packs, and cool the patient.

  14. Outcomes Compare your level of confidence from the malignant hyperthermia education you received in the past with the recent 2018 ECT MH Mock Event simulation to understand and operationalize the various roles involved in responding to an actual MH event.

  15. The Keys to a Successful Training • Identify stakeholders & get approval • Dedicated planning committee • Regular meeting times • Current structures & processes • Gap analysis • Monthly action plan • Organize the simulation activity • Identify key dept. staff and ensure availability • Evaluate outcomes to plan for future training

  16. Questions?

  17. References • Acadoodle.com. (n.d.). 5 ECG Changes of Hyperkalemia you Need to Know – Acadoodle. Retrieved from https://acadoodle.com/articles/5-ecg-changes-of-hyperkalemia-you-need-to-know • Hausman, K. A., & Ignatavicius, D. D. (2002). Clinical Companion for Medical-Surgical Nursing: Critical Thinking for Collaborative Care. Philadelphia, PA: W.B. Saunders Company • Kirschner, P.A., Sweller, J., Kirschner, F., Zambrano, J.R. (2018). From cognitive load theory to collaborative cognitive load theory. International Journal of Computer-Supported Collaborative Learning. 13:213-233. Https://doi.org/10.1007/s11414-018-9277-y. • Lederer, E. (2018, June 20). Hyperkalemia: Practice Essentials, Background, Pathophysiology. Retrieved from https://emedeicine.medscape.com/article/240903-overview • Malignant Hyperthermia Plan. Sharp Healthcare Policy and Procedure Guidelines #46815.00, Revised 08/2014 • Malignant Hyperthermia Association of the United States Official Website (www.MHAUS.org). • Standards, Recommended Practices and Guidelines. Association of Perioperative Registered Nurses • Swartz, C. & Abrams, R. (2002): What you need to know about Electroconvulsive Therapy. Illinois: Somatics, LLC • Urden, L. D., Stacy, K. M., Lough, M. E. (2010). Critical Care Nursing: Diagnosis and Management. St. Louis, MO: Mosby Elsevier • Wilson, K. P. (2012). Treatment of Malignant Hyperthermia in an Outpatient Surgery Center; Are you prepared [PowerPoint slides]. Retrieved August 30, 2018 from slideshare.net

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