A Quality Improvement Initiative to Decrease Sugammadex Expenditures

Abstract

Abstract A Quality Improvement Initiative to Decrease Sugammadex Expenditures Jordan Gardo Introduction/Background: The manufacturer’s suggestion in the dosing of the Sugammadex is generally dosed at 2-4 mg/kg of total body weight (TBW) depending on the extent of neuromuscular blockade. Evidence suggests that in the morbidly obese population, this can lead to excessive dosing due to the drug\u27s hydrophilic properties, making it less cost- effective. Dosing based on adjusted body weight (ABW) leads to dose reductions while achieving full reversal of neuromuscular blockade as measured by quantitative train-of- four monitoring, resulting in lower costs from decreased vial usage. Purpose: The purpose of this project was to implement adjusted body weight dosing of sugammadex to decrease the cost associated with the drug while maintaining patient safety. The project utilized a combination of evidence-based education, intraoperative decision support, and email feedback to promote ABW dosing while ensuring complete neuromuscular blockade reversal occurred, as indicated by train-of-four monitoring. Intervention: The Certified Registered Nurse Anesthesiology (CRNA) department at a community hospital received education via PowerPoint presentation on the new dosing method, the evidence supporting it, and how to determine the dose. To maintain consistency, the department received cyclical, specific feedback and support throughout the project. Methods: This project employed the Institute for Healthcare Improvement (IHI) improvement model as its framework. Within this model, the Plan-Do-Study-Act (PDSA) system functioned as a cyclical process to guide the quality improvement initiative for implementing adjusted body weight dosing for sugammadex in morbidly obese patients. Results: Nineteen post-intervention and thirteen pre-intervention patients with BMI ≥ 40 were included. ABW-based sugammadex dosing was utilized in 6 of 19 post-intervention cases (31%). Compared to TBW dosing, ABW dosing reduced the average drug cost from $238.34 to$139.03. Total cost savings over three PDSA cycles equaled $595.85, with projected annual savings of$5,164.03 at the observed adoption rate. A t-test comparing post-intervention ABW vs. TBW costs yielded a statistically significant result (p = 0.004), supporting the intervention’s effectiveness in reducing expenditures without compromising neuromuscular recovery. Neuromuscular blockade reversal was 100% effective. However, provider adherence was lower than expected (31%), indicating a need for improved engagement strategies. No adverse clinical outcomes were observed, and the project showed strong potential for cost savings with further optimization. Conclusions: ABW dosing for sugammadex offers a feasible and cost-effective alternative to recommended TBW-based dosing in morbidly obese patients. With just a 50% adoption rate, dosing based on ABW could save approximately $8,333.11 annually. This highlights the financial benefits and suggests that higher adoption rates could lead to even greater savings. Future efforts should focus on increasing provider engagement, adding a permanent display of ABW in the electronic medical record, and expanding implementation to enhance its impact. These findings support ABW dosing as a viable strategy for reducing medication costs while maintaining clinical efficacy