Measure Abbreviation
NMB-02
Data Collection Method

This measure is calculated based on data extracted from the electronic medical record combined with administrative data sources such as professional fee and discharge diagnoses data.  This measure is explicitly not based on provider self-attestation.

Measure Type
Process
Description

Administration of Neostigmine, Sugammadex, and/or Edrophonium before extubation for cases with non-depolarizing neuromuscular blockade.

Measure Time Period

Anesthesia Start to Earliest Extubation

Inclusions

All patients that have received a non-depolarizing neuromuscular blocker (NMB) AND were extubated post-operatively. 

The following NMBs given as bolus, defasciculating doses or infusion are included and require reversal:

  • Atracurium
  • Cisatracurium
  • Pancuronium
  • Rocuronium
  • Vecuronium
Exclusions
  • ASA 5 and 6 cases.
  • Patients that were not extubated in the immediate post-operative period.
  • Patients not given NMBs
Success

Documentation of neostigmine, Sugammadex, and/or edrophonium before earliest extubation OR An acceleromyography ratio of ≥ 0.9 documented after last dose of NMB and before earliest extubation.

Other Measure Build Details

Cases that recieve defasciculating doses of NMBs are included in this measure and require documentation of neostigmine, sugammadex or edrophonium before earliest extubation to pass.

Responsible Provider

The provider(s) signed in at time of earliest extubation.

Threshold
90%
MPOG Concept IDs Required

Neuromuscular Blocker Medications

Reversal Agents

 

Extubation

Train of Four

 

10043

Atracurium

10170

Edrophonium

50127

Intubation Extubated Awake or Deep

3485

Train-of-four (Acceleromyography)

10129

Cisatracurium

10315

Neostigmine

50202

Emergence- Patient Extubated

 

10344

Pancuronium

10739

Sugammadex

50145

Airway – Laryngeal mask airway removed (deep or awake)

10393

Rocuronium

 

10446

Vecuronium

 

Data Diagnostics Affected
  • Percentage of Cases with a Non-Depolarizing NMB Administration
  • Percentage of Cases with an Extubation Note
  • Percentage of Cases with Neuromuscular Blocker Reversal Agents Administered
  • Percentage of Medications with a Meaningful Medication Mapping
  • Percentage of Cases with any Staff Tracking
  • Percentage of Anesthesia Provider Sign-Ins that are Timed
Rationale

Postoperative residual neuromuscular blockade can lead to significant complications.1,2  Several studies have found associations between the use of neuromuscular blockade agents (NMBA) and residual neuromuscular blockade in the recovery room.   Adverse postoperative respiratory outcomes are even more frequent when patients receive NMBA and reversal agents are not used.  A mainstay of residual blockade prevention continues to be monitoring to allow for detection, and use of reversal agents like neostigmine and sugammadex.3-5 Due to variability in duration of muscle relaxants, even in defasciculating doses, we recommend that TOF is monitored when any non-depolarizing neuromuscular blockers are administered.

References
  1. McLean DJ, Diaz-Gil D, Farhan HN, Ladha KS, Kurth T, Eikermann M. Dose-dependent Association between Intermediate-acting Neuromuscular-blocking Agents and Postoperative Respiratory Complications. Anesthesiology. 2015;122(6):1201-1213.
  2. Murphy GS, Szokol JW, Avram MJ, et al. Residual Neuromuscular Block in the Elderly: Incidence and Clinical Implications. Anesthesiology. 2015;123(6):1322-1336.
  3. Brull SJ, Murphy GS. Residual neuromuscular block: lessons unlearned. Part II: methods to reduce the risk of residual weakness. Anesthesia and analgesia. 2010;111(1):129-140.
  4. Bulka CM, Terekhov MA, Martin BJ, Dmochowski RR, Hayes RM, Ehrenfeld JM. Nondepolarizing Neuromuscular Blocking Agents, Reversal, and Risk of Postoperative Pneumonia. Anesthesiology. 2016;125(4):647-655.
  5. Lien CA, Kopman AF. Current recommendations for monitoring depth of neuromuscular blockade. Current opinion in anaesthesiology. 2014;27(6):616-622.