PMID- 34990997
OWN - NLM
STAT- MEDLINE
DCOM- 20220303
LR  - 20220303
IS  - 1873-4529 (Electronic)
IS  - 0952-8180 (Linking)
VI  - 77
DP  - 2022 May
TI  - Use of provider education, intra-operative decision support, and an 
      email-feedback system in improving compliance with sugammadex dosage guideline 
      and reducing drug expenditures.
PG  - 110627
LID - S0952-8180(21)00470-0 [pii]
LID - 10.1016/j.jclinane.2021.110627 [doi]
AB  - STUDY OBJECTIVE: Due to excessive sugammadex expenditures at our institution, we 
      designed dosing guidelines that utilize adjusted body weight and 
      informatics-based tools aimed at reducing variability in dosing practices. 
      DESIGN: We retrospectively reviewed rates of high-dose sugammadex administration 
      in three phases: Pre-intervention - May 2018 to November 2018; First intervention 
      - November 2018 to April 2019; and Second intervention - April 2019 to July 2019. 
      SETTING: Academic medical center in the United States - Vanderbilt University 
      Medical Center (VUMC) PATIENTS: N/A INTERVENTIONS: First, anesthesia providers 
      were educated on adjusted body weight-based dosing guidelines. Providers also 
      received intraoperative decision support displaying a patient's actual and 
      adjusted body weight along with rates of high-dose (>200 mg) sugammadex 
      administration for each respective provider. Second, we implemented an 
      email-feedback system to remind providers of the new guidelines. MEASUREMENTS: 
      Weekly rate of high-dose sugammadex cases. MAIN RESULTS: During the 
      pre-intervention stage, 1556 (12.3%) cases involved high-dose sugammadex. 
      Comparatively, 550 (4.3%) and 187 (3.1%) high-dose sugammadex cases occurred 
      during the first and second intervention stages, respectively. Segmented 
      regression analysis demonstrated a significant rate change of -3.51% (95% CI: 
      -5.64%, -1.38%) in sugammadex dosing practices after provider education and the 
      implementation of digital improvement initiatives but failed to reveal a 
      significant change after implementation of the email-feedback system. Overall, 
      our interventions were associated with $2563.05 in estimated weekly savings of 
      sugammadex expenditures. CONCLUSIONS: Provider education and digital quality 
      improvement was associated with reduced rates of high-dose sugammadex 
      administration, generating cost savings at a large academic medical institution.
CI  - Copyright (c) 2021 Elsevier Inc. All rights reserved.
FAU - Pregnall, Andrew M
AU  - Pregnall AM
AD  - Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, 
      TN, USA.
FAU - Gupta, Rajnish K
AU  - Gupta RK
AD  - Department of Biomedical Informatics, Vanderbilt University Medical Center, 
      Nashville, TN, USA.
FAU - Clifton, Jacob C
AU  - Clifton JC
AD  - Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, 
      TN, USA. Electronic address: jacob.c.clifton@vumc.org.
FAU - Wanderer, Jonathan P
AU  - Wanderer JP
AD  - Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, 
      TN, USA; Department of Biomedical Informatics, Vanderbilt University Medical 
      Center, Nashville, TN, USA.
LA  - eng
PT  - Journal Article
DEP - 20220103
PL  - United States
TA  - J Clin Anesth
JT  - Journal of clinical anesthesia
JID - 8812166
RN  - 0 (Pharmaceutical Preparations)
RN  - 361LPM2T56 (Sugammadex)
RN  - 3982TWQ96G (Neostigmine)
SB  - IM
MH  - Electronic Mail
MH  - Feedback
MH  - Health Expenditures
MH  - Humans
MH  - Neostigmine
MH  - *Neuromuscular Blockade
MH  - *Pharmaceutical Preparations
MH  - Retrospective Studies
MH  - Sugammadex
OTO - NOTNLM
OT  - Cost
OT  - Neostigmine
OT  - Sugammadex
EDAT- 2022/01/07 06:00
MHDA- 2022/03/04 06:00
CRDT- 2022/01/06 20:25
PHST- 2021/08/17 00:00 [received]
PHST- 2021/12/01 00:00 [revised]
PHST- 2021/12/02 00:00 [accepted]
PHST- 2022/01/07 06:00 [pubmed]
PHST- 2022/03/04 06:00 [medline]
PHST- 2022/01/06 20:25 [entrez]
AID - S0952-8180(21)00470-0 [pii]
AID - 10.1016/j.jclinane.2021.110627 [doi]
PST - ppublish
SO  - J Clin Anesth. 2022 May;77:110627. doi: 10.1016/j.jclinane.2021.110627. Epub 2022 
      Jan 3.