IMPLEMENTATION OF A INTRAOPERATIVE COGNITIVE AID TO GUIDE NEUROMUSCULAR BLOCKADE MONITORING

Residual neuromuscular blockade (rNMB) following general anesthesia can impair pulmonary mechanics and place patients at an increased risk to develop postoperative pulmonary complications (PPCs) (Saagar et al., 2019). PPCs are associated with increased readmission rate, hospital length of stay and overall morbidity and mortality (Kirmeier et al., 2019). Current literature suggests that clinicians play a pivotal role in the reduction of rNMB through the accurate assessment and interpretation of neuromuscular blockade with a peripheral nerve stimulator (PNS) (Thilen & Bhananker, 2016). For this project, a survey was distributed to anesthesia providers at a level-1 trauma center. Nine questions regarding neuromuscular blockade monitoring were included; two questions assessed current practice and seven questions assessed literature-based knowledge. The survey results revealed that while some content areas reflected up-to-date practice and knowledge by the practitioners, others did not align with current literature. For example, only 12.9% of survey participants correctly identified the most important and reliable use of the train-of-four count (TOFC), the most commonly used mode of the PNS. The identified areas of educational needs were identified via the survey and included on a cognitive aid to be used as an intra-operative reference tool. This quality improvement project recommends continuing the evaluation and analysis of current practice trends as new literature and management modalities evolve.