Effect of a Cognitive Aid on Reducing Sugammadex Use and Associated Costs

Abstract

Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background The authors observed increased pharmaceutical costs after the introduction of sugammadex in our institution. After a request to decrease sugammadex use, the authors implemented a cognitive aid to help choose between reversal agents. The purpose of this study was to determine if sugammadex use changed after cognitive aid implementation. The authors’ hypothesis was that sugammadex use and associated costs would decrease. Methods A cognitive aid suggesting reversal agent doses based on train-of-four count was developed. It was included with each dispensed reversal agent set and in medication dispensing cabinet bins containing reversal agents. An interrupted time series analysis was performed using pharmaceutical invoices and anesthesia records. The primary outcome was the number of sugammadex administrations. Secondary outcomes included total pharmaceutical acquisition costs of neuromuscular blocking drugs and reversal agents, adverse respiratory events, emergence duration, and number of neuromuscular blocking drug administrations. Results Before cognitive aid implementation, the number of sugammadex administrations was increasing at a monthly rate of 20 per 1,000 general anesthetics (P < 0.001). Afterward, the monthly rate was 4 per 1,000 general anesthetics (P = 0.361). One month after cognitive aid implementation, the number of sugammadex administrations decreased by 281 per 1,000 general anesthetics (95% CI, 228 to 333, P < 0.001). In the final study month, there were 509 fewer sugammadex administrations than predicted per 1,000 general anesthetics (95% CI, 366 to 653; P < 0.0001), and total pharmaceutical acquisition costs per 1,000 general anesthetics were $11,947 less than predicted (95% CI, $4,043 to $19,851; P = 0.003). There was no significant change in adverse respiratory events, emergence duration, or administrations of rocuronium, vecuronium, or atracurium. In the final month, there were 75 more suxamethonium administrations than predicted per 1,000 general anesthetics (95% CI, 32 to 119; P = 0.0008). Conclusions Cognitive aid implementation to choose between reversal agents was associated with a decrease in sugammadex use and acquisition costs.

Optimizing neuromuscular blockade management for improving patient safety and peri-operative outcomes: a pilot phase of a quality improvement initiative

“…Drzymalski et al . [ 15 ] conducted a single-center study that included cognitive aid to help clinicians to choose between NMB reversal agents. This project was developed due to an increased cost after the introduction of sugammadex in their institution.…”

Identifying high dose neostigmine as a risk factor for post-operative respiratory complications: a case-control study

“…Most quality improvement interventions find that short-term effects are rarely sustained. However, several recent studies suggest that cognitive aids (e.g., a card that can be used at the point of care to remind clinicians about dosing strategies) may result in more long-term effects [ 8 , 17 ]. Prospective studies are needed to determine whether interventions, such as cognitive aids to guide clinicians on evidence-based approaches to reversal of neuromuscular blockade, may help to decrease the incidence of post-operative respiratory complications and their subsequent effects on patient outcomes.…”

Hereditary pseudocholinesterase deficiency discovery after electroconvulsive therapy

“…As illustrated by this case, using rocuronium and sugammadex for all ECT patients prophylactically is challenging from a monetary standpoint, because sugammadex currently costs around US$200 per single dose vial in the USA 18. Many institutions have implemented guidelines to only use sugammadex in selected cases 19…”