Implementing Sugammadex Disclosure to Female Patients in the Preoperative and Postoperative Setting

Abstract

Problem: Sugammadex is given to reverse the effects of NMB agents; however, this reversal agent decreases the efficacy of hormonal contraceptives, increasing the risk of unintended pregnancy. At a primary care hospital in Maryland, less than 1% of anesthesia providers correctly completed the sugammadex disclosure form and only 10% of anesthesia providers reported administration of sugammadex intraoperatively during PACU handoff. Purpose: The purpose of this quality improvement initiative was to implement sugammadex disclosure in the postoperative setting and include a completed sugammadex disclosure form in the patient’s discharge packet to all female patients of childbearing age undergoing laparoscopic procedures. Methods: In the months preceding the project, an interdisciplinary team of stakeholders was mobilized to plan evidenced-based structure and workflow changes. Anesthesia and PACU providers were trained on completing the sugammadex disclosure form, reporting intraoperative sugammadex administration, and including the sugammadex disclosure form in the patient discharge instructions. Weekly chart audits were conducted to track project compliance. Approximately eighty female patients of childbearing age were impacted over the implementation period. Results: 60% of PACU and anesthesia providers received in-person training and 100% received electronic communication about the new protocol. The rate of completed sugammadex disclosure forms was 43.5% and 24.7% included the sugammadex disclosure form in patient discharge instructions. Conclusions: Findings suggest low PACU compliance with including sugammadex disclosure in patient discharge instructions. Low compliance may be related to the multi-step process with some steps done electronically and some done on paper. Inclusion of sugammadex disclosure in patient discharge instructions may be increased if added to the electronic health record.