Quantitative Neuromuscular Monitoring in Clinical Practice: A Professional Practice Change Initiative.

Area of Science:

• Anesthesiology
• Patient Safety
• Pharmacology

Background:

• Residual neuromuscular blockade is a common complication of anesthesia.
• Quantitative neuromuscular monitoring can prevent residual neuromuscular blockade.
• Achieving adequate neuromuscular recovery is crucial for patient outcomes.

Purpose of the Study:

• To implement a professional practice initiative to achieve documented train-of-four (TOF) ratios ≥ 0.90 in all patients.
• To reduce residual paralysis and improve patient outcomes.
• To assess the impact of quantitative monitoring on neuromuscular blockade reversal.

Main Methods:

• Retrospective assessment of anesthesia records (2016-2020) and electronic medical charts.
• Utilized equipment trials, educational videos, quantitative monitors, and electronic clinical decision support.
• Manual review of 2,807 anesthesia records and electronic search of 20,181 patient charts.

Main Results:

• Documentation of TOF ratios ≥ 0.90 increased from 1% (November 2016) to 93% (December 2020).
• Postimplementation, 92% of patients achieved TOF ratios ≥ 0.90.
• Inpatients experienced shorter PACU and hospital lengths of stay, and fewer pulmonary complications.

Conclusions:

• A professional practice initiative successfully increased documented TOF ratios ≥ 0.90 to 93% in a clinical setting.
• Improved neuromuscular recovery is an intermediate outcome contributing to better patient outcomes.
• Quantitative monitoring is effective in reducing residual neuromuscular blockade.