The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

SIMULATION TECHNOLOGY USED TO INCREASE CLINICAL CONFIDENCE OF MALIGNANT HYPERTHERMIA DETECTION

Joel M. Brown1, Francis A. Gott1, Megan Boyle1, Charles Fort2, John S. Emberger1; 1Respiratory Care, Christiana CareHealth System,Newark, DE; 2Academic Affairs, Christiana CareHealth System,Newark, DE

Background: Inhaled isoflurane is a vital therapy used for the management of status asthmaticus (SA) patients. Inhaled isoflurane is infrequently used since it is typically reserved for the most severe SA patients. A side effect of inhaled isoflurane is malignant hyperthermia (MH). Limited exposure to both isoflurane and MH lead to RCP’s having difficulty maintaining the clinical confidence needed to provide this therapy. In a previous study we published evidence that demonstrated the use of set clinical objectives and a staff self assessment increases the clinical confidence of RCP’s. In this study, we added the use of a simulation designed to present a patient with SA who develops MH. The purpose of this study was to assess the effect of using simulation on the RCP’s self-reported clinical confidence in the detection of MH. Method: We provided 14 RCP’s with formal education on the delivery of inhaled isoflurane via the Drager Apollo® Inhalation Anesthesia Machine and MH. Each RCP then received electronic references for self-learning. Three months later we re-sent the electronic references to the RCP’s via e-mail. The RCP’s were given a self assessment after receiving the formal education and electronic references. A simulation was designed to mimic a severe SA patient that would develop MH once the isoflurane was delivered. The Meti HPS® adult simulator was used for this study. After completing the simulation the RCP’s were given the same self assessment. Two to eight weeks later the RCP’s were then taken back for another simulation (different patient history and setting with the same outcomes). Self assessments were repeated before and after the 2nd VEST lab experience. The self assessment and case scenario were developed to include 9 objectives used during the formal education and were scored using the following 4-point Likert scale: 1 = unable to perform objective, 2 = able to perform objective with instruction, 3 = able to perform with a reference, 4 = able to perform objective. Results: Fourteen RCP’s completed the formal education and the first VEST experience. Twelve completed the second VEST experience. None of the RCP’s witnessed MH prior to this study. The RCP’s clinical confidence increased for all 9 objectives. See attached Table#1 for additional data. Conclusion: Our results indicate that the use of the VEST lab can increase an RCP’s confidence in their ability to detect MH during isoflurane delivery. Sponsored Research - None

Self Assessment Scores

Table#1: This table depicts the average self assessment score for all participants of the study. *p= <0.05

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