EFFECT OF PRESCRIBING GUIDELINES ON THE USE OF NEUROMUSCULAR BLOCKING-AGENTS

Citation
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
Citations number
7
Categorie Soggetti
Pharmacology & Pharmacy
ISSN journal
10792082
Volume
52
Issue
17
Year of publication
1995
Pages
1900 - 1904
Database
ISI
SICI code
1079-2082(1995)52:17<1900:EOPGOT>2.0.ZU;2-U
Abstract
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.