Using Informatics to Improve the Care of Patients Susceptible to Malignant Hyperthermia.

Perioperative nurses and nurse leaders should understand how to apply a nursing informatics framework and informatics concepts to strengthen data interpretation, transitions in care, and engagement with patients susceptible to malignant hyperthermia (MH) and their family members. Patient outcomes can be improved when informatics solutions facilitate identifying risks, clinical decision making in a crisis situation, retrieving priority information during transitions of care, and involving patients in planning care. Incorporating informatics solutions into existing quality improvement processes can help evaluate knowledge and preparedness related to managing care for a patient in an MH crisis. Informatics solutions can also help enhance interoperability by evaluating workflow related to transitions in care. Perioperative nurses and nurse leaders should advocate for diligence in submitting reports of MH-suspected events to databases. Improved data collection and data sharing enhance aggregated standardized data sets, which can advance research and increase the quality of evidence available with which to guide practice.

Using a Vulnerability Theoretical Model to Assess the Malignant Hyperthermia Susceptible Population: Implications for Advanced Practice Emergency Nurses.

Malignant hyperthermia (MH) is a high-risk, low-occurrence medical emergency with symptoms that include a severe increased rate of metabolic activity and rigid skeletal muscles. Clinicians should be knowledgeable and prepared for an MH event because it can occur in areas outside the operating room and without anesthetic triggers. Patients who have this rare genetic condition may come to the emergency department (ED) presenting with symptoms of heat stroke. However, the incidence of suspected MH in the ED or other critical care areas is not easily quantifiable because clinicians may not report cases to a centralized registry. The purpose of this article is to describe the MH-susceptible vulnerable population, to apply a vulnerability theoretical model to assess patients and families, to identify strategies for health promotion to reduce vulnerability, and to discuss how advanced practice nurses who specialize in emergency care can help decrease the vulnerability of MH-susceptible patients and families. By using a vulnerability model to assess the MH-susceptible population, nurses can effectively sort out strategies to prevent poor patient outcomes related to MH and promote health for this high-risk population. Measuring accurate core temperatures, applying effective cooling methods, and administering dantrolene are key concepts in caring for a patient who is experiencing an MH event. Advanced practice emergency nurses can participate in reducing vulnerability for this population by applying the Emergency Nurses Association Clinical Nurse Specialist competencies to MH-related vulnerabilities. Enhancing preparedness, evaluating and coordinating education programs, advocating for report submissions to the North American Malignant Hyperthermia Registry, and assessing opportunities for community collaboration are among the strategies discussed for reducing vulnerability for the MH-susceptible population.

Implementing AORN recommended practices for care of patients undergoing pneumatic tourniquet-assisted procedures.

Perioperative nurses are likely to encounter the use of pneumatic tourniquets in a variety of operative and invasive extremity procedures. Use of a pneumatic tourniquet offers an opportunity to obtain a near-bloodless surgical field; however, the use of tourniquets is not without risk. Unfavorable outcomes include pain, thrombotic events, nerve compression injuries, and disruption of skin integrity. Perioperative nurses should be familiar with the indications, contraindications, and changes in physiology associated with pneumatic tourniquet use. The revised AORN "Recommended practices for care of patients undergoing pneumatic tourniquet-assisted procedures" is focused on the perioperative nurse's role in patient care and provides guidance for developing, implementing, and evaluating practices that promote patient safety and improve the likelihood of positive outcomes.

Implementing AORN recommended practices for medication safety.

Medication errors in the perioperative setting can result in patient morbidity and mortality. The AORN "Recommended practices for medication safety" provide guidance to perioperative nurses in developing, implementing, and evaluating safe medication use practices. These practices include recognizing risk points in the medication use process, collaborating with pharmacy staff members, conducting preoperative assessments and postoperative evaluations (eg, medication reconciliation), and handling hazardous medications and pharmaceutical waste. Strategies for successful implementation of the recommended practices include promoting a basic understanding of the nurse's role in the medication use process and developing a medication management plan as well as policies and procedures that support medication safety and activities to measure compliance with safe practices.