Intensive Care Nurses' Knowledge About Use of Neuromuscular Blocking Agents in Patients With Respiratory Failure.
BACKGROUND
The recent increase in use of neuromuscular blocking agents (NMBAs) in patients with acute respiratory distress syndrome is set against a backdrop of concerns about harm associated with use of these high-risk drugs. Bedside nurses play a pivotal role in the safe and effective use of these agents.


OBJECTIVE
To describe critical care nurses' knowledge of the therapeutic properties, adverse effects, and monitoring parameters associated with NMBAs.


METHODS
A prospective, multicenter survey of medical intensive care unit nurses between July 2012 and May 2013. The web-based survey instrument was designed, pretested, and administered under the direction of a multidisciplinary group of individuals.


RESULTS
Responses from 160 nurses (22% of eligible nurses) were analyzed. Most respondents were able to identify NMBAs correctly as nonanalgesic (93%) and nonanxiolytic (83%). The perceived durations of action of NMBAs varied widely, and few nurses were familiar with patient-specific considerations related to drug elimination. Most (70%) recognized the independent associations between NMBAs and footdrop, muscle breakdown, and corneal ulceration. Pressure ulcers and a history of neuromuscular disease were the characteristics of patients perceived to most heighten the risk of NMBA use.


CONCLUSIONS
Critical care nurses are knowledgeable about the importance of concurrent analgesia and sedation during use of NMBAs. Routes of elimination, duration of action, and adverse effects were less commonly known and represent areas for focused education and quality improvement surrounding use of NMBAs in the intensive care unit.
Erin N. Frazee and Heather A. Personett are pharmacists in Hospital Pharmacy Services, Mayo Clinic, Rochester, Minnesota. Seth R. Bauer is a medical intensive care unit clinical specialist in the Department of Pharmacy, Cleveland Clinic, Cleveland, Ohio. Amy L. Dzierba is a critical care pharmacist in the Department of Pharmacy, New York Presbyterian Hospital, New York, New York. Joanna L. Stollings is a critical care pharmacist in the Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, Tennessee. Lindsay P. Ryder is a pharmacist in the Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, Ohio. Jennifer L. Elmer is a critical care clinical nurse specialist in the Department of Nursing at the Mayo Clinic. Sean M. Caples and Craig E. Daniels are intensive care physicians in the Division of Pulmonary and Critical Care Medicine, Mayo Clinic. frazee.erin@mayo.edu.
Erin N
EN
Frazee
Erin N. Frazee and Heather A. Personett are pharmacists in Hospital Pharmacy Services, Mayo Clinic, Rochester, Minnesota. Seth R. Bauer is a medical intensive care unit clinical specialist in the Department of Pharmacy, Cleveland Clinic, Cleveland, Ohio. Amy L. Dzierba is a critical care pharmacist in the Department of Pharmacy, New York Presbyterian Hospital, New York, New York. Joanna L. Stollings is a critical care pharmacist in the Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, Tennessee. Lindsay P. Ryder is a pharmacist in the Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, Ohio. Jennifer L. Elmer is a critical care clinical nurse specialist in the Department of Nursing at the Mayo Clinic. Sean M. Caples and Craig E. Daniels are intensive care physicians in the Division of Pulmonary and Critical Care Medicine, Mayo Clinic.
Heather A
HA
Personett
Erin N. Frazee and Heather A. Personett are pharmacists in Hospital Pharmacy Services, Mayo Clinic, Rochester, Minnesota. Seth R. Bauer is a medical intensive care unit clinical specialist in the Department of Pharmacy, Cleveland Clinic, Cleveland, Ohio. Amy L. Dzierba is a critical care pharmacist in the Department of Pharmacy, New York Presbyterian Hospital, New York, New York. Joanna L. Stollings is a critical care pharmacist in the Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, Tennessee. Lindsay P. Ryder is a pharmacist in the Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, Ohio. Jennifer L. Elmer is a critical care clinical nurse specialist in the Department of Nursing at the Mayo Clinic. Sean M. Caples and Craig E. Daniels are intensive care physicians in the Division of Pulmonary and Critical Care Medicine, Mayo Clinic.
Seth R
SR
Bauer
Erin N. Frazee and Heather A. Personett are pharmacists in Hospital Pharmacy Services, Mayo Clinic, Rochester, Minnesota. Seth R. Bauer is a medical intensive care unit clinical specialist in the Department of Pharmacy, Cleveland Clinic, Cleveland, Ohio. Amy L. Dzierba is a critical care pharmacist in the Department of Pharmacy, New York Presbyterian Hospital, New York, New York. Joanna L. Stollings is a critical care pharmacist in the Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, Tennessee. Lindsay P. Ryder is a pharmacist in the Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, Ohio. Jennifer L. Elmer is a critical care clinical nurse specialist in the Department of Nursing at the Mayo Clinic. Sean M. Caples and Craig E. Daniels are intensive care physicians in the Division of Pulmonary and Critical Care Medicine, Mayo Clinic.
Amy L
AL
Dzierba
Erin N. Frazee and Heather A. Personett are pharmacists in Hospital Pharmacy Services, Mayo Clinic, Rochester, Minnesota. Seth R. Bauer is a medical intensive care unit clinical specialist in the Department of Pharmacy, Cleveland Clinic, Cleveland, Ohio. Amy L. Dzierba is a critical care pharmacist in the Department of Pharmacy, New York Presbyterian Hospital, New York, New York. Joanna L. Stollings is a critical care pharmacist in the Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, Tennessee. Lindsay P. Ryder is a pharmacist in the Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, Ohio. Jennifer L. Elmer is a critical care clinical nurse specialist in the Department of Nursing at the Mayo Clinic. Sean M. Caples and Craig E. Daniels are intensive care physicians in the Division of Pulmonary and Critical Care Medicine, Mayo Clinic.
Joanna L
JL
Stollings
Erin N. Frazee and Heather A. Personett are pharmacists in Hospital Pharmacy Services, Mayo Clinic, Rochester, Minnesota. Seth R. Bauer is a medical intensive care unit clinical specialist in the Department of Pharmacy, Cleveland Clinic, Cleveland, Ohio. Amy L. Dzierba is a critical care pharmacist in the Department of Pharmacy, New York Presbyterian Hospital, New York, New York. Joanna L. Stollings is a critical care pharmacist in the Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, Tennessee. Lindsay P. Ryder is a pharmacist in the Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, Ohio. Jennifer L. Elmer is a critical care clinical nurse specialist in the Department of Nursing at the Mayo Clinic. Sean M. Caples and Craig E. Daniels are intensive care physicians in the Division of Pulmonary and Critical Care Medicine, Mayo Clinic.
Lindsay P
LP
Ryder
Erin N. Frazee and Heather A. Personett are pharmacists in Hospital Pharmacy Services, Mayo Clinic, Rochester, Minnesota. Seth R. Bauer is a medical intensive care unit clinical specialist in the Department of Pharmacy, Cleveland Clinic, Cleveland, Ohio. Amy L. Dzierba is a critical care pharmacist in the Department of Pharmacy, New York Presbyterian Hospital, New York, New York. Joanna L. Stollings is a critical care pharmacist in the Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, Tennessee. Lindsay P. Ryder is a pharmacist in the Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, Ohio. Jennifer L. Elmer is a critical care clinical nurse specialist in the Department of Nursing at the Mayo Clinic. Sean M. Caples and Craig E. Daniels are intensive care physicians in the Division of Pulmonary and Critical Care Medicine, Mayo Clinic.
Jennifer L
JL
Elmer
Erin N. Frazee and Heather A. Personett are pharmacists in Hospital Pharmacy Services, Mayo Clinic, Rochester, Minnesota. Seth R. Bauer is a medical intensive care unit clinical specialist in the Department of Pharmacy, Cleveland Clinic, Cleveland, Ohio. Amy L. Dzierba is a critical care pharmacist in the Department of Pharmacy, New York Presbyterian Hospital, New York, New York. Joanna L. Stollings is a critical care pharmacist in the Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, Tennessee. Lindsay P. Ryder is a pharmacist in the Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, Ohio. Jennifer L. Elmer is a critical care clinical nurse specialist in the Department of Nursing at the Mayo Clinic. Sean M. Caples and Craig E. Daniels are intensive care physicians in the Division of Pulmonary and Critical Care Medicine, Mayo Clinic.
Sean M
SM
Caples
Erin N. Frazee and Heather A. Personett are pharmacists in Hospital Pharmacy Services, Mayo Clinic, Rochester, Minnesota. Seth R. Bauer is a medical intensive care unit clinical specialist in the Department of Pharmacy, Cleveland Clinic, Cleveland, Ohio. Amy L. Dzierba is a critical care pharmacist in the Department of Pharmacy, New York Presbyterian Hospital, New York, New York. Joanna L. Stollings is a critical care pharmacist in the Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, Tennessee. Lindsay P. Ryder is a pharmacist in the Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, Ohio. Jennifer L. Elmer is a critical care clinical nurse specialist in the Department of Nursing at the Mayo Clinic. Sean M. Caples and Craig E. Daniels are intensive care physicians in the Division of Pulmonary and Critical Care Medicine, Mayo Clinic.
Craig E
CE
Daniels
D002983:Clinical Competence / Q000706:statistics & numerical data*; D003422:Critical Care / Q000379:methods*; D064648:Critical Care Nursing / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D016903:Drug Monitoring; D019538:Health Care Surveys / Q000706:statistics & numerical data; D006801:Humans; D009466:Neuromuscular Blocking Agents / Q000494:pharmacology*; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000188:drug therapy*
D009466:Neuromuscular Blocking Agents