Development of a Clinical Practice Guideline for the Use of Sugammadex

Abstract

Ineffective reversal of neuromuscular blockade is a prevalent issue for patients recovering from anesthesia, impacting over a third of our perioperative patient populations. This issue imposes the risk of postoperative complications for perioperative patients that can lead to prolonged operating room stay, prolonged recovery room stay, unplanned re-intubations, and unwarranted intensive care admissions. There is a new reversal agent, sugamamdex, which is revolutionizing how anesthesia providers are reversing neuromuscular blockade, in that it provides more timely and effective reversal. Sugammadex has recently been approved by the Food and Drug Administration (FDA), many hospitals remain reluctant to have it available on their hospital formulary. The main purpose of this Doctor of Nursing Practice (DNP) project was to develop an evidence-based clinical practice guideline (CPG) for the regulated use of sugammadex as an alternative reversal agent, to be used by anesthesia providers at a hospital in the Phoenix area. The objective is to motivate implementation of evidence-based recommendations for sugammadex by providing a high quality guideline to key leaders of the organization to promote and implement change. The Knowledge to Action Framework was utilized as the quality improvement, conceptual framework to encourage translation of current evidence into best practices. Expert practitioners (N=4) utilized the Appraisal of Guidelines for Research & Evaluation II (AGREE II) as an assessment tool to determine the quality and applicability of the developed CPG. The CPG’s overall assessment achieved a score of 96%, leading to each appraiser recommending its use without modifications. Results were disseminated to key anesthesia leaders who presented the guidelines to the pharmacy and therapeutics committee which resulted in the addition of sugammadex for use by anesthesia.