Perceptions Among CRNAs on Qualitative Versus Quantitative Monitoring for the Assessment of Residual Neuromuscular Blockade

Abstract

Neuromuscular blockade medications are frequently administered during general anesthesia. Residual neuromuscular blockade is assessed with qualitative or quantitative devices to determine the amount of blockade remaining at the end of surgery. Despite guideline recommendations for a TOF ratio ≥ 0.9 by quantitative monitoring prior to emergence and extubation, there continues to be inconsistency in applying this guideline to clinical practice. 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. A single plan-do-study-act cycle was used to perform this project. Pre- and post- surveys were delivered to participants via email and included an educational video. Quantitative monitoring devices remained available during the implementation period for all participants within the organization. Four out of five CRNAs within the project setting participated in the quality improvement project. Survey questions addressed current use and perceptions of neuromuscular blockade monitoring. Most participants used a PNS to quantify neuromuscular blockade and viewed acceleromyography measurement as neutral. The acceleromyography device was used by 25-75% of CRNAs during the implementation period. Participants reported an increase in the use of the acceleromyography devices as well as increased likelihood of use after project completion, suggesting that implementation of a similar quality improvement project may impact practice thus benefitting patient safety and accuracy of residual neuromuscular blockade measurement.