Author(s): Zeinali D.; Vas-Falcao A.; McMenamin M.
Source: Anaesthesia; Jan 2018; vol. 73 ; p. 49
Publication Date: Jan 2018
Publication Type(s): Conference Abstract
Available at Anaesthesia – from Wiley Online Library Full Collection
Abstract:NAP 5 identified that the use of a peripheral nerve stimulator could prevent 88% of cases of awareness during emergence from general anaesthesia . Subsequent AAGBI guidance states that neuromuscular monitoring should be used in all cases in which neuromuscular blocking drugs (NMBs) are used . This quality improvement project identified barriers to the use of neuromuscular monitoring and improved compliance with AAGBI recommendations. Methods We carried out a prospective, questionnaire based, closed-loop audit of use of neuromuscular monitoring in our anaesthetic department over 1 week in May 2016 and May 2017. Respondents were asked about their usage of neuromuscular monitoring and to identify any perceived barriers to its use. We checked knowledge of the 2015 AAGBI recommendations. This was accompanied by an assessment of the number of working nerve stimulators in each theatre area. We then provided education for staff at audit meetings. Results There were 34 respondents to the original survey. Among those using NMBs (n = 26), neuromuscular monitoring was used in 62% of cases. Availability of a nerve stimulator was identified as a barrier to use by 50% of respondents. Other barriers identified included poorly functioning devices and cases of long duration. There was no working nerve stimulator in 4/20 theatres. We presented these data to the Trust, leading to the purchase of 8 new units. The number of nerve stimulators was increased to at least 1 per theatre. We educated the department on the 2015 AAGBI guidance. A repeat survey of practice (n = 38) revealed that availability of neuromuscular monitoring was 27% less frequently identified as a barrier to its use (identified by 23%). Importantly, among those using NMBs (n = 31), use of neuromuscular monitoring was increased by 12% (74% of cases). Discussion The dangers of residual neuromuscular blockade can largely be prevented by the use of a peripheral nerve stimulator. We found that practice in our department could be improved and demonstrated that having working equipment available was the most significant barrier to the use of neuromuscular monitoring. Following our initial audit, we educated staff about current recommendations and combined this with the purchase of new devices. We showed an increase in our usage of monitoring and hence improvement in patient safety. We hope that with more education we can change perceptions and further improve usage of monitoring for all cases.