Operationalizing quantitative neuromuscular monitoring in perioperative practice: A pharmacy-led framework for health systems

Quantitative neuromuscular monitoring is recommended by the American Society of Anesthesiologists to reduce the incidence of residual neuromuscular blockade; however, adoption has been inconsistent across anesthetizing locations. Pharmacists are positioned to lead implementation efforts through their roles in medication safety, stewardship, education, and quality improvement. This article describes a pharmacy-led framework for operationalizing neuromuscular monitoring in health systems.

Residual neuromuscular blockade is present in approximately 10% of patients after sugammadex reversal and is associated with postoperative complications. Reliance on clinical assessment or qualitative neuromuscular assessment fails to detect residual neuromuscular blockade. This narrative review outlines a 6-step implementation framework to assist health systems in adopting quantitative neuromuscular monitoring. These steps include (1) establishing baseline practices and building the case for change; (2) selection of monitoring equipment; (3) development of educational strategies; (4) monitoring workflow integration; (5) troubleshooting; and (6) tracking success metrics. The framework emphasizes pharmacist leadership opportunities, including in protocol development, reversal strategies, cost stewardship, performance feedback, and alignment with safety and quality initiatives.

Operationalizing quantitative neuromuscular monitoring requires coordinated practice change. Pharmacist-led implementation of quantitative neuromuscular monitoring offers a structured approach to improving patient safety, optimizing use of reversal agents, and advancing perioperative medication and patient safety. Adoption of this framework can expand pharmacy practice and reinforce pharmacist leadership in perioperative medication management.