The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts


Joel M. Brown1, Francis A. Gott1, Megan D. Boyle1, Chuck 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. Isoflurane is infrequently used because it is typically reserved for the most severe SA patients. A side effect of inhaled isoflurane is malignant hyperthermis (MH). Limited exposure to both isoflurane and MH can hinder the RCP’s ability to retain the clinical competence needed to recognize this hazard. In a previous study, we published evidence that demonstrated using set clinical objectives and a staff self assessment increased the clinical competence of RCP’s. In this study, we added the use of a simulation designed to present a patient with SA who develops MH after inhaled isoflurane induction. Method: Fourteen RCP’s received formal classroom education on the delivery of inhaled isoflurane via the Drager Apollo® Inhalation Anesthesia Machine (Apollo) and MH. Each RCP received electronic references for self-learning. Three months later we re-sent the electronic references via e-mail. We then randomly selected the RCP’s to go to the VEST Center for the simulation. 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. Two to eight weeks later the RCP’s were randomly selected for another simulation (different patient history and setting with the same outcomes). The performance of each RCP was observed and scored by 2 trained reviewers. The simulation included 12 clinical competencies that were developed to include the 9 objectives used during the formal education. The competencies were scored with 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 formal education and the first simulation experience. Twelve RCP’s attended the second VEST experience. None of the RCP’s witnessed MH in a real life clinical environment. There was improvement in all 12 competencies and MH detection time improved. Four of the fourteen participants detected MH during the 1st VEST experience. All participants detected MH in the 2nd VEST experience. See Table #1 for additional data. Conclusion: The use of simulation technology can increase an RCP’s clinical competence for the management of SA patients, use of the Apollo, and the detection of MH during isoflurane delivery. Sponsored Research - None

Competency Results

Table#1: This table depicts the average scores obtained by the participating RCP’s.

*p=<0.05. **This number represents data collected from 4 out of the 14 RCP’s