35 - I Remember That! Gamification in Malignant Hyperthermia Management Training

Description: Description of team:
Malignant Hyperthermia (MH) crisis is fatal event that can happen in the perioperative setting. MH is a genetic condition where the skeletal muscles affect myoplasmic calcium homeostasis. According to the Malignant Hyperthermia Association of the United States (2024), MH is a biochemical response that can be caused by inhalation anesthetics and succinylcholine. Unfamiliarity to the management of the crisis will result in management delay and can lead to patient death. The purpose of this quality improvement project is to increase knowledge and confidence of perioperative team at an urban, tertiary, academic teaching medical center.

Preparation and planning:
An interdisciplinary team consisting of perioperative leadership, OR nurses, anesthesia partners and simulation specialists plan a process test. A simulation scenario for an adult MH crisis was created for the perioperative setting. The NPDS added gamification to create an engaging learning environment. In a 2021 study by Van Gaalen, et al, it showed that gamification is a promising tool to improve learning outcomes by strengthening learning behaviors and attitudes towards learning.

Assessment:
The quality improvement project seeks to assess the level of engagement of the team in a MH simulation exercise. A 11-item post simulation questionnaire was created to measure effectiveness of the simulation exercise.

Implementation:
A game-based education with knowledge checks was conducted to establish baseline education amongst operating room staff. An in-situ simulation exercise followed to provide a high-fidelity environment. A pre-briefing was completed to set the stage of the simulation. Key competencies were included in the exercise. These include time of signs and symptoms recognition, delivery of MH medication and alerting the charge nurse of the emergency. An After-Action report was completed to identify opportunities for improvement.

Outcome:
Staff confidence scored at 92.3% in managing an MH crisis in the operating room. 100% recommends the simulation exercise as an annual activity for the perioperative team. The team identified six latent safety threats and created action plans for each threat.

Implications for perioperative nursing:
Simulation based training is recommended for high-risk, low-volume events in the perioperative setting. The exercise provides a realistic and safe environment for nurses, surgical technologists, and allied partners to apply and enhance their knowledge in MH management.