Download Malignant Hyperthermia Competency checklist

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University Health Care System
This checklist is designed for use with multiple roles and can be used as an electronic document or printed out and completed manually.
Please complete the sections on this page by placing an X or marking as N/A in the box provided.
Date:
Name/Title:
Evaluator:
Competency Priority Code
Self-Assessment
Initial competency (must be completed at orientation)
Can perform without assistance
Completion within 90 days
Need assistance to perform
Completion within 6 months
Need supervision when performing
Specialty competency
Unable to perform
Prerequisites
Didactic (see reading list in next section)
Meet Perform Preoperative Nursing Assessment competency, Assist Anesthesia Provider with Induction/Endotracheal Intubation competency, Respond
to Patient Emergencies competency, Administer and Monitor Moderate Sedation/Analgesia competency, Provide and Receive Hand-Off Communication
competency, Document Perioperative Nursing Care in the Electronic Medical Record competency
Prerequisites - Required Reading (all references current edition unless noted)
AORN: Perioperative Standards and Recommended Practices
Rothrock, JC (ed): Alexander’s Care of the Patient in Surgery - Chapter 2: Patient Safety and Risk Management; Chapter 5: Anesthesia
Unit Policy/Procedure/Clinical Guidelines
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Copyright © 2015, 2011, 2007 by Mosby, Inc., an imprint of Elsevier Inc.
Checklists – Competency Assessment
Competency Elements
Please note: Not all attributes may be applicable to the role you are evaluating. Each attribute is worth one point. If the attribute is met, mark a “1” in the Met
column. If the attribute is not met, mark a “0” in the Not Met column. If an attribute does not apply to the situation or role, please mark it as N/A. Note the
performance code in the Performance Code column. Use the Comments section to make any notes about how the attribute was handled. Total the score in
the space provided.
Performance Codes
Recommended Validation_________________
Please use the following codes to indicate the method of performance validation:
DS:
Return demonstration - Simulated
DA:
Return demonstration - Actual (real time in actual procedure)
V:
Verbal explanation
C:
Case Study
Met
Not Met
N/A
1 point
0 point
0 point
Performance
Code
Comments
Define and identify predisposing risk factors for MH: history of fever
during surgery, anesthesia complications, muscular disease.
Identify MH crisis–triggering anesthetic agents: succinylcholine,
halothane volatile gas.
Discuss process of typical muscle contraction and pathophysiology of
MH crisis.
Describe physiologic signs of MH and potential systemic effects.
Identify location and contents of MH cart/box.
Describe MH crisis management priorities and actions with the direct
patient care: eliminating triggering agents, mixing dantrolene, cooling
measures, sending blood for arterial blood gases, inserting urinary and
gastric catheters, ice packs.
Describe MH crisis management priorities and actions that need to
occur beyond direct patient care: secure ICU bed, call Malignant
Hyperthermia Association of the United States (MHAUS).
Describe appropriate role functions for licensed and unlicensed staff
during an MH crisis.
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Copyright © 2015, 2011, 2007 by Mosby, Inc., an imprint of Elsevier Inc.
Checklists – Competency Assessment
Describe/demonstrate dantrolene (Dantrium) reconstitution procedure
and adjunct meds: insulin, glucose, diuretics, sodium bicarbonate.
Describe commonly occurring postevent complications.
List patient/family education priorities.
Totals
Scoring Interpretation
Total Score
Zone
9 to 11 Points (85%-100%)
Mastery Zone
8 Points (70%-84%)
Building Zone
7 and Below (69% and Less)
Developing Zone
Action Plan:
Learner Goals and Timeframe:
Use the space below to make any additional notes:
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Copyright © 2015, 2011, 2007 by Mosby, Inc., an imprint of Elsevier Inc.