Ml. Goraharper et al., EFFECT OF PRESCRIBING GUIDELINES ON THE USE OF NEUROMUSCULAR BLOCKING-AGENTS, American journal of health-system pharmacy, 52(17), 1995, pp. 1900-1904
The effect of prescribing guidelines on the use of neuromuscular block
ing agents (NMBs) was studied. Voluntary guidelines on the appropriate
prescribing of formulary NMBs in the operating rooms at a university
hospital were approved in January 1993. Patients who underwent inpatie
nt surgery with neuromuscular blockade during a preguideline period (M
arch 1, 1992, through May 31, 1992) or a postguideline period (March 1
, 1993, through May 31, 1993) were randomly selected (n = 200 per grou
p) and compared to determine the relative appropriateness, effectivene
ss, safety, and cost of NMB use. The preguideline and postguideline gr
oups were demographically similar. There were significantly more insta
nces of appropriate NMB use after than before the guidelines were esta
blished. Neuromuscular blockade was maintained in all patients. The ov
erall rates of NMB-associated adverse events were 5.5% and 7.5% for th
e preguideline and postguideline groups, respectively. The acquisition
cost of NMBs and drugs used to treat NMB-associated adverse events fo
r the preguideline patients was $4261, versus $2978 for the postguidel
ine patients. Extrapolated to the estimated 10,000 operations per year
requiring neuromuscular blockade at the institution,the total cost wa
s $213,000 before guideline introduction and $149,000 afterward, for a
guideline-associated cost reduction of $64,000. Prescribing guideline
s reduced expenditures for NMBs without affecting clinical outcomes.