How do you keep your staff ready to respond to a rare but potentially deadly event like malignant hyperthermia? Practice drills. In 2015, we put together a formal MH response plan and have conducted simulations in each of the past 2 years. During both drills, we exposed a few weak links that should help us improve our ability to respond in the event of an MH crisis. Here's what we learned.
Don't assume your OR team is familiar with MH. Before our first simulation, we learned that most of our staff was unaware of their roles in an MH crisis. We ordered instructional materials from the Malignant Hyperthermia Association of the United States (MHAUS) and updated our existing MH cart according to MHAUS guidelines with the proper drugs, equipment and supplies (osmag.net/ZawGX3). A lot goes into stocking an MH cart. The long list of drugs alone includes dantrolene, sterile water for injection USP, sodium bicarbonate, dextrose, calcium chloride, regular insulin, lidocaine and refrigerated cold saline solution.
We also assigned nurses and surgical techs to take an MH course and conducted an in-service to the entire perioperative staff. This included a PowerPoint presentation "The ABCs of Managing MH," outlining each team member's role during an MH crisis, from pre-op to post-op, including the need to ask about any personal or family history of MH during patients' pre-admission assessments and a mock-drill DVD from MHAUS.
Initially, we kept our MH cart in the core area, but the simulations taught us that location wasn't convenient for PACU, ICU or pre-op. We moved the cart out of the sterile area and into a neutral space in the hallway across from the front desk so it's more accessible to anyone in perioperative care.