- Email: [email protected]
Does Mandatory Nursing Education on Malignant Hyperthermia Enhance Nursing Knowledge and Lead to Positive Patient Outcomes?
ASPAN NATIONAL CONFERENCE ABSTRACTS DOES MANDATORY NURSING EDUCATION ON MALIGNANT HYPERTHERMIA ENHANCE NURSING KNOWLEDGE AND LEAD TO POSITIVE PATIENT OUTCOMES? Team Leader: Debbie Fracassi, MS RN-BC, Perioperative Services University of Rochester Medical Center, Rochester, New York Team Members: Monica Seaman, MS RN CAPA, Emergency Department, Nancy Freeland, MS RN CCRN, Critical Care, Julie Gottfried, MS RN CCRN CPNP-PC, Pediatrics, Heather O’Brien, MS RN CNS, Psychiatry
Background Information: Malignant Hyperthermia (MH) is a rare, potentially lethal patient syndrome caused by a hypermetabolic state that can be precipitated by the administration of volatile inhalation anesthetic agents or depolarizing muscle relaxants. It is essential to be prepared for this rare event that has a very high risk of death to the patient if it occurs without immediate treatment with Dantrium. Education to all nursing staff caring for patients undergoing procedures or surgery that utilize the anesthesia triggering agents is essential. MH education in perioperative services has been ongoing for several years. The hospital’s Nursing Education Council recognized that education should occur in additional areas that may care for this specialized population. A committee was formed consisting of the service educators from pediatrics, critical care, psychiatry, emergency and perioperative services. Objectives of Project: Determine if an increase in the knowledge and skills of nursing staff to respond emergently to manage a MH crisis leads to positive patient outcomes. Process of Implementation: 1. The self-learning education module was developed by the education committee and placed on the institutions online learning management system. 2. Education strategies included a PowerPoint presentation, a “how to mix Dantrolene” video and a news clip of a teenage girl who died from MH because of an inadequate supply of Dantrolene. 3. Education was mandatory for all identified areas that administer any of the triggering anesthesia agents and contact hours were awarded for the activity. Statement of Successful Practice: In the first quarter after education was rolled out a total of 866 nursing staff completed the education with very positive comments. Greater than 92% of participants reported good or excellent achievement of the learning objectives. Shortly after rollout of this education, there was a 16 year old patient that was diagnosed and treated for MH in an offsite outpatient ambulatory surgical center, transferred to the ED and then to the pediatric ICU. The patient outcome was positive, with discharge to home within 48 hours. Positive comments from nursing staff followed from several different services that the education prepared them for caring for this MH patient in crisis. Interdisciplinary debriefing occurred at multiple levels after the event to review patient care and enhance learning.
Note: All abstracts are printed as received from the authors.
e29
Implications for Advancing the Practice of Perianesthesia Nursing: There was Successful Translation of Education to Clinical Practice in the emergent care of the MH patient. By providing the essential education through a variety of strategies, we enhanced new knowledge and skills of our nursing staff to utilize best practices in caring for the rare MH patient.
THE JOHNS HOPKINS EVIDENCE BASED PRACTICE (EBP) MODEL: LEARNING THE PROCESS AND APPRAISING THE EVIDENCE Team Leaders: Patricia L. Ryan, MSN MHA RN CPAN, Myrna Mamaril, MS RN CPAN CAPA FAAN, Bonnie Shope, MS RN CPAN The Johns Hopkins Hospital, Baltimore, Maryland Team Members: Jing Rodriguez, BSN RN CPAN, Tamara Garey, BSN RN, Luz Obedoza, BSN RN CPAN, Eloisa Martinez, BSN RN CPAN, Melinda Walker, BSN RN, Martha Conlon, BSN RN, Elizabeth Morse, DM MSN MPA NEA-BC
Background Information: Historically, nurses identified leveling and appraising the evidence as the most challenging part of the Evidence Based Practice (EBP) process. The Johns Hopkins PACU Standards of Care (SOC) Committee recommended a plan that included both members and bedside nursing staff in leveling and appraising the evidence. Perianesthesia nursing staff identified the need to prescreen all patients undergoing anesthesia or sedation for Obstructive Sleep Apnea (OSA). Screening for obstructive sleep apnea (OSA) in pre-sedation and pre-anesthesia patients is vital because as many as 93% of the patients with OSA potentially go unidentified (Persuade, 2010). This topic for appraising evidence was chosen because the nurses reported that there was no standard method of prescreening for OSA in the perianesthesia area. Objectives of Project: Educate nursing staff to The Johns Hopkins Nursing EBP model Mentor staff nurses in appraising the evidence Process of Implementation: All nurses involved in the project completed The Johns Hopkins Nursing EBP online learning modules prior to the start of leveling and appraising the evidence A mentor for each work group was identified to assist the nurses in rating evidence PubMed, SCOPUS and CINAHL were used to identify 19 articles relating to OSA screening tools which spoke to the PICO question PACU SOC Committee and unit based nursing staff participated in leveling and appraising the evidence Statement of Successful Practice: PACU SOC Committee recommended adopting STOPBANG tool Johns Hopkins Hospital integrated STOPBANG into the electronic medical record All patients in adult perianesthesia areas are screened using STOPBANG tool in Prep In PACU Phase I, all patients screened at high risk are monitored for hypoventilation, desaturation, and bradycardia
Background Information: Malignant Hyperthermia (MH) is a rare, potentially lethal patient syndrome caused by a hypermetabolic state that can be precipitated by the administration of volatile inhalation anesthetic agents or depolarizing muscle relaxants. It is essential to be prepared for this rare event that has a very high risk of death to the patient if it occurs without immediate treatment with Dantrium. Education to all nursing staff caring for patients undergoing procedures or surgery that utilize the anesthesia triggering agents is essential. MH education in perioperative services has been ongoing for several years. The hospital’s Nursing Education Council recognized that education should occur in additional areas that may care for this specialized population. A committee was formed consisting of the service educators from pediatrics, critical care, psychiatry, emergency and perioperative services. Objectives of Project: Determine if an increase in the knowledge and skills of nursing staff to respond emergently to manage a MH crisis leads to positive patient outcomes. Process of Implementation: 1. The self-learning education module was developed by the education committee and placed on the institutions online learning management system. 2. Education strategies included a PowerPoint presentation, a “how to mix Dantrolene” video and a news clip of a teenage girl who died from MH because of an inadequate supply of Dantrolene. 3. Education was mandatory for all identified areas that administer any of the triggering anesthesia agents and contact hours were awarded for the activity. Statement of Successful Practice: In the first quarter after education was rolled out a total of 866 nursing staff completed the education with very positive comments. Greater than 92% of participants reported good or excellent achievement of the learning objectives. Shortly after rollout of this education, there was a 16 year old patient that was diagnosed and treated for MH in an offsite outpatient ambulatory surgical center, transferred to the ED and then to the pediatric ICU. The patient outcome was positive, with discharge to home within 48 hours. Positive comments from nursing staff followed from several different services that the education prepared them for caring for this MH patient in crisis. Interdisciplinary debriefing occurred at multiple levels after the event to review patient care and enhance learning.
Note: All abstracts are printed as received from the authors.
e29
Implications for Advancing the Practice of Perianesthesia Nursing: There was Successful Translation of Education to Clinical Practice in the emergent care of the MH patient. By providing the essential education through a variety of strategies, we enhanced new knowledge and skills of our nursing staff to utilize best practices in caring for the rare MH patient.
THE JOHNS HOPKINS EVIDENCE BASED PRACTICE (EBP) MODEL: LEARNING THE PROCESS AND APPRAISING THE EVIDENCE Team Leaders: Patricia L. Ryan, MSN MHA RN CPAN, Myrna Mamaril, MS RN CPAN CAPA FAAN, Bonnie Shope, MS RN CPAN The Johns Hopkins Hospital, Baltimore, Maryland Team Members: Jing Rodriguez, BSN RN CPAN, Tamara Garey, BSN RN, Luz Obedoza, BSN RN CPAN, Eloisa Martinez, BSN RN CPAN, Melinda Walker, BSN RN, Martha Conlon, BSN RN, Elizabeth Morse, DM MSN MPA NEA-BC
Background Information: Historically, nurses identified leveling and appraising the evidence as the most challenging part of the Evidence Based Practice (EBP) process. The Johns Hopkins PACU Standards of Care (SOC) Committee recommended a plan that included both members and bedside nursing staff in leveling and appraising the evidence. Perianesthesia nursing staff identified the need to prescreen all patients undergoing anesthesia or sedation for Obstructive Sleep Apnea (OSA). Screening for obstructive sleep apnea (OSA) in pre-sedation and pre-anesthesia patients is vital because as many as 93% of the patients with OSA potentially go unidentified (Persuade, 2010). This topic for appraising evidence was chosen because the nurses reported that there was no standard method of prescreening for OSA in the perianesthesia area. Objectives of Project: Educate nursing staff to The Johns Hopkins Nursing EBP model Mentor staff nurses in appraising the evidence Process of Implementation: All nurses involved in the project completed The Johns Hopkins Nursing EBP online learning modules prior to the start of leveling and appraising the evidence A mentor for each work group was identified to assist the nurses in rating evidence PubMed, SCOPUS and CINAHL were used to identify 19 articles relating to OSA screening tools which spoke to the PICO question PACU SOC Committee and unit based nursing staff participated in leveling and appraising the evidence Statement of Successful Practice: PACU SOC Committee recommended adopting STOPBANG tool Johns Hopkins Hospital integrated STOPBANG into the electronic medical record All patients in adult perianesthesia areas are screened using STOPBANG tool in Prep In PACU Phase I, all patients screened at high risk are monitored for hypoventilation, desaturation, and bradycardia