Neuromuscular Blockade Monitoring: Assessing Nurse Anesthetists’ Perceptions of the Usefulness of and Preference for Qualitative versus Quantitative Measurements: A Quality Improvement Project

Abstract

Anesthesia providers are responsible for administering neuromuscular blocking agents, monitoring the level of blockade, and ensuring adequate reversal of these medications prior to extubation of surgical patients. Despite guideline recommendations to have a train-of-four ratio ≥ 0.9 by quantitative monitoring prior to emergence, there continues to be inconsistency in applying this standard. The purpose of this quality improvement project was to assess anesthesia providers' perceptions of the usefulness of and preference for using qualitative (PNS) versus quantitative (acceleromyography) neuromuscular blockade reversal measurements in the perioperative setting. An educational PowerPoint with voiceover recording along with a short video were developed to educate nurse anesthetists on residual neuromuscular blockade and demonstrate usage of the acceleromyography device. Qualtrics software was utilized to survey participants prior to and after a two-week device implementation period. All participants reported using peripheral nerve stimulators and/or clinical assessment such as head tilt, spontaneous breathing, etc. as their usual method for assessment of neuromuscular blockade, as well as all having had an episode with a patient experiencing residual neuromuscular blockade. Half of participants reported likelihood of future device use as only somewhat likely. Availability and time were two of the major barriers identified to using acceleromyography devices. Although it took all participants less than four minutes to set up and use the device, it was more time consuming than their usual methods. Future research is needed to address providers’ perceptions regarding the impact and implications of residual neuromuscular blockade on patients’ recovery.