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Abstract
Background: The administration of neuromuscular blocking drugs often accompanies general anesthesia. Subjective neuromuscular monitoring techniques do not consistently detect residual neuromuscular blockade before tracheal extubation. The current recommendation is to achieve a train-of-four ratio (TOFr) of at least 0.9 before tracheal extubation. This can only be accomplished by using quantitative neuromuscular monitoring (QNM). Patients are at an increased risk of respiratory complications and increased length of stay in the PACU when QNM is not used. Methods: This DNP project was a quality improvement (QI) initiative to increase the usage of QNM and improve patient outcomes. A pre-intervention survey was administered to the staff before an educational intervention on the usage of QNM. One month later, a post-intervention survey was given to the staff. Knowledge, comfort level, perceptions, and barriers were measured with the surveys. De-identified patient chart reviews were also analyzed to evaluate patient outcomes. Results: A two-sample t-test compared pre-intervention PACU times to the post-intervention PACU times. There was no significant difference in PACU times between the two groups (p=0.81). Survey results did not reveal significant changes in knowledge, comfort level, or perceptions of QNM when comparing pre/post-survey responses. However, there was a significant increase in CRNAs who acknowledged existing barriers to using QNM after the intervention (pre-intervention - 46%; post-intervention - 69%). Conclusion: QNM is effective in preventing the incidence of residual neuromuscular blockade which decreases the risk of respiratory complications postoperatively. However, barriers such as time constraints and surgical positioning prevent CRNAs at the site from routinely using QNM to monitor neuromuscular blockade.