Effect of pharmaceutical services on adherence to criteria-for-use guidelines in the operating room

Guidelines for the use of neuromuscular blocking agents (NMBAs) and sedativ es during two- to four-hour surgical procedures were developed, and the eff ect of pharmacy presence on adherence to the guidelines was determined. Differences in cost per dose of the NMBAs pancuronium bromide, cisatracuriu m besylate, and vecuronium bromide were determined. Pancuronium was designa ted as the first-line agent in the NMBA guidelines, cisatracurium as the se cond-line agent, and vecuronium as the third-line agent. In the sedative gu idelines, lorazepam was the first-line agent, midazolam was the second-line agent, and propofol was the third-line agent. Pharmacy presence in the ope rating room was provided during January 1997. The pharmacist made a prelimi nary decision about the most appropriate agent and encouraged guideline adh erence. Cost and adherence data were compared with data for November 1996 a nd March 1997. During January, the NMBA guidelines were followed 75% of the time and the s edative guidelines were followed 15% of the time; the corresponding rates f or March were 40% and 12%. Compared with November 1996, a saving of $5.61 p er case was observed in January in the NMBA category and a saving of $2.77 was observed in March; between January and March, there was an increase of $2.84 per case. Pharmacy presence in the OR was associated with better adherence to criteri a-for-use guidelines for NMBAs and sedatives; NMBA cost savings associated with implementation of the guidelines were higher when a pharmacist was pre sent.