How to Implement Quantitative Neuromuscular Monitoring into
Your Practice
Ross Renew, MD - Mayo Clinic, Florida
Risks of residual neuromuscular blockade include hypoxemia, impaired pulmonary
function, upper airway obstruction, postop pneumonia, and respiratory failure.
Assessment Nomenclature:
● Clinical assessment = 5 –sec head lift, grip strength, etc…
● Subjective evaluation = Peripheral nerve stimulator (PNS)
● Quantitative (objective) monitoring = monitor that stimulates a peripheral nerve,
measures the response to stimulation, and converts this signal to objective data
2023 ASA Practice Guidelines for Monitoring & Antagonism of NMB
Refer to Dr. Ross Renew’s presentation for practical interpretation and
application of these recommendations.
Reimagining our Patients and Their Care: Simple (and not so simple)
changes to improve surgical patient care.
Practicing Gratitude:
Emotional exhaustion (EE) in health care providers is common and linked to lower quality of care.
● A single-exposure trial conducted by Adair and colleagues (2020), found that writing a gratitude letter improved
well-being.
● 1575 health care workers
● Significant improvements in emotional exhaustion, happiness, and work-life balance between the intervention and
1-week follow-up (P<.001).
Moving Forward:
● Typical concerns of patients: What’s scary?
● Points of contact : Preop & Induction. Asking patients to describe their top travel destination during induction.
● Environmental changes : Calming environments reduce stress -> better outcomes
Afton Hassett, Psy. D- Associate Professor University of Michigan
Perioperative Psychological stress = Poor Outcomes
● Resilience strongly predicts chronic pain outcomes.
● Build resilience by engaging in pleasant activities, savoring, and acts of kindness.
ASPIRE Quality Improvement Stories
PAIN 01 - Holland Hospital
Quality Champion: Chris Wedeven, MD
ACQR: Amy Poindexter, BSN, RN
● Began tracking scores 2019
● Created an order set that was completed
in February 2023 to add oral
acetaminophen for pre-op sedation
● >25% improvement in performance!
PONV 05 - Henry Ford - W. Bloomfield
Quality Champion: Bryan Cohen, MD
ACQR: Kim Finch, MSN, RN
● Monitored performance starting in Jan 2022
● Released 3 Epic PONV prophylaxis BPAs in May
2022 (available in Epic BPA library)
● Involved system-wide committee for PONV
education
● More than 2-fold improvement system-wide!
● Educational materials:
○ Emails
○ BPA posters
○ Educational 1-2 page flyers regarding risk factors
and ways to reduce PONV
Health Equity and Social Determinants of Health.
● MSHIELD CQI (Michigan Social Health Interventions to Eliminate Disparities)
is a “partnering CQI”
● MSHIELD has expertise in working with data involving social determinants of
health and health disparities
● One of MSHIELD’s primary goals is to be a partner to all existing CQIs to help
each CQI achieve their quality improvement goals in a way that advances
health equity
MSHIELD: Carol Gray, MPH and Matthias Kirch, MS
For more information, visit https://www.michiganshield.org/
