Cognitive aid for malignant hyperpyrexia.

Abstract

AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Jenkins's editorial 1 made a strong argument for the use of visual aids and checklists when dealing with emergency situations. Cognitive aids are important tools, especially in rare emergencies such as malignant hyperpyrexia (MH). This specific anaesthetic emergency requires multiple high-priority tasks to be carried out simultaneously. We have produced task allocation cards (Fig. 2), which have been demonstrated to be a useful tool 2, from the AAGBI guidelines on MH 3. As stated by Jenkins, the ideal cognitive aid should be based on best practice guidelines, appropriate for use in an emergency, in a familiar format, and aid all members of the team to manage the crisis. We encompassed all of these factors within our task allocation cards. We divided aspects of the management of MH into specific jobs for specific healthcare professionals (e.g. secondary anaesthetist manages resuscitation, operating department practitioner draws up dantrolene) and, importantly, did not deviate from the AAGBI guidelines. Our laminated and lanyard-mounted task allocation cards are stored with the MH emergency trolley and are to be handed out and worn when managing MH. The cards are produced in the same format (font, colour scheme, etc.) as the AAGBI documents so as to be familiar, even when used for the first time. They are clear and self-explanatory so the person handed the card can perform the task, even if it is not his/her usual job. We also used visual images with text when the task may be a multi-step process, such as the reconstitution of dantrolene. Figure 2Open in figure viewerPowerPoint Task allocation cards for MH crisis. Another key aspect in the use of national guidelines is their adaptation to the local environment for which they are to be used. We included important local information on our task allocation cards such as the location of fridge packs, cooling equipment and further stores of dantrolene. We then ran real-time simulations in theatre to assess the practicalities of the management, logistics and team structures relating to a case of MH. Debriefing sessions with the multidisciplinary team who had used the task cards highlighted areas for modification. Based on this feedback, the task allocation cards were improved and re-trialled in a simulation environment. It is difficult to prove improvement in patient care with cognitive aids. However, we found that the use of task allocation cards enabled vials of dantrolene to be reconstituted approximately 2 min faster. The teams worked well with the cards and all members found them helpful and easy to use. The production of our cognitive aids and use of multidisciplinary team simulation have helped increase awareness of a specific anaesthetic emergency and improved teamworking and confidence when facing a patient with MH. We suggest that organisations should test the feasibility of new guidelines within their own environment and with their own team structures. Minor adaptations can then be made in a manner that enhances the effectiveness of the guideline within the local environment without detracting from the universality of a nationally developed guideline. References 1Jenkins B. Cognitive aids: time for change? Anaesthesia 2014; 69: 660– 8. 2Gillies R, Street N, Pollock N et al. MH Resource Kit. http://www.anaesthesia.mh.org.au/mh-resource-kit//w1/i1002692/ (accessed 25/06/2014). 3 Association of Anaesthetists of Great Britain and Ireland. Malignant Hyperthermia Crisis. Safety Guideline. http://www.aagbi.org/sites/default/files/mh_guideline_for_website.pdf (accessed 25/06/2014). Citing Literature Volume69, Issue9September 2014Pages 1058-1060 FiguresReferencesRelatedInformation