Introduction: Critically ill patients receiving continuous neuromuscular blockade (NMBA) infusions are at high risk for medication errors and safety events. A prior evaluation revealed inconsistent use of continuous sedation to ensure amnesia during paralysis, along with other supportive care gaps. In 2012, an EPIC orderset was implemented, improving sedation ordering by facilitating fixed-dose sedation and related measures. However, reviewing sedation appropriateness remained labor-intensive, requiring over 25 hours of manual chart review for one month of data, with no sustainable method for ongoing quality improvement. Methods: We collaborated with informatics, nursing, and pharmacy leads to create an electronic automated report that captures total NMBA days, the type of NMBA agent used, and the use of appropriate supportive care during paralysis. Six key focus areas were identified: stress ulcer prophylaxis, DVT prophylaxis, ocular lubrication to prevent exposure keratopathy, fixed-dose continuous sedation, and fixed-dose continuous analgesia. Each report captured six months of data at a time. After the report was developed, three rounds of code iteration and data validation were completed before its official launch. Results: An automated biannual NMBA report was successfully launched in 2018. Reports containing six months of NMBA data were evaluated, validated, and presented at the monthly multidisciplinary Adult Critical Care Committee to review fallouts and identify areas for improvement, such as education and orderset enhancements. Improvements were observed across all six areas of supportive care, with the most significant gains in concomitant continuous sedation infusion (from 89.7% to 98.8%) and continuous analgesia infusion (from 85.0% to 92.4%). Ocular lubrication also improved from 93.9% to 99.4%. This report has been reviewed every six months for the past seven years and remains a core component of our quality measures. Conclusions: The use of an electronic automated report improves the efficiency of EHR data extraction, enabling a consistent evaluation every 6 months of this patient safety measure. Making such a report available across EPIC platforms could support broader institutional efforts to improve quality and standardize care for patients receiving continuous neuromuscular blockade.
Thornton et al. (Sun,) studied this question.