Perceptions of Qualitative Versus Quantitative Monitoring for the Assessment of Postoperative Residual Neuromuscular Blockade Among CRNAs: A Quality Improvement Project

Abstract

There are two categories of monitoring neuromuscular blockade: qualitative and quantitative. There is no defined method supported by the AANA, creating the potential for misdiagnosis and misinterpretation of residual neuromuscular blockade (rNMB) and potential patient outcomes. The purpose of this quality improvement project was to assess anesthesia providers' perceptions of the usefulness of and preference for qualitative peripheral-nerve-stimulator (PNS) versus quantitative acceleromyography (ACM) neuromuscular blockade reversal measurements in the perioperative setting of a level one trauma center located in the eastern United States. The intervention consisted of an educational video slideshow demonstrating how to operate and interpret quantitative assessment of neuromuscular blockade. Pre- and post-intervention surveys were used to gather data. A review of pre-intervention data showed that participants did not routinely utilize quantitative methodology despite having had a patient experience rNMB. Post-intervention data showed increased utilization and increased likelihood of future use of ACM. Standardizing monitoring of neuromuscular blockade monitoring with quantitative methodology has the potential to reduce incidence of residual neuromuscular blockade, which is linked to poor patient outcomes, prolonged hospitalization, and increased patient costs.