[Impact of a quality assurance program on the use of neuromuscular monitoring and reversal of muscle relaxants].
BACKGROUND
As part of a quality assurance in the anaesthesia department, this study was designed to enhance the rate of neuromuscular blockade monitoring for patients receiving muscle relaxant during anaesthesia.


METHODS
After approval of our local ethical committee, we assessed 200 computerized anaesthesia records in which neuromuscular relaxants were used. The following data were collected: demographic characteristics, durations of anaesthesia and surgery, use of neuromuscular monitoring, reversal agents and the quality of neuromuscular monitoring. The results were discussed with all anaesthesia providers of the department and an internal guideline was elaborated with the endpoint that all patients having muscle relaxants should have quantitative neuromuscular monitoring. Six months later, another assessment of 200 consecutive records collected the same data to check the efficiency of the elaborated guideline.


RESULTS
The monitoring rate was of 67% at the first assessment and increased to 94% (p<0.05). The reversal rate was at 48% in the first assessment and was stable at the second assessment (50%). The rate of patients not monitored and not reversed decreased from 5 to 2% (p<0.05).


CONCLUSIONS
This study shows that as part of a quality assurance program systematic quantitative monitoring of neuromuscular blockade can be significantly increased.
Motamed
C
C
Service d'anesthésie-réanimation, institut Gustave-Roussy, 39, rue Camille-Desmoulins, 94805 Villejuif cedex, France. motamed@igr.fr
Bourgain
J-L
JL
D000328:Adult; D000368:Aged; D000762:Anesthesia Recovery Period; D001279:Atracurium / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics; D004558:Electric Stimulation / Q000295:instrumentation / Q000379:methods; D004568:Electrodiagnosis / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data*; D019148:Neuromuscular Blockade / Q000009:adverse effects* / Q000379:methods; D009468:Neuromuscular Diseases / Q000139:chemically induced* / Q000453:epidemiology; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics; D011183:Postoperative Complications / Q000139:chemically induced* / Q000453:epidemiology; D015397:Program Evaluation; D011785:Quality Assurance, Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D009435:Synaptic Transmission
D003473:Neuromuscular Nondepolarizing Agents; D001279:Atracurium