804: SUGAMMADEX (BRIDION) MEDICATION USE EVALUATION IN A 591-BED TEACHING HOSPITAL

Abstract

Introduction: Sugammadex is a modified gamma cyclodextrin encapsulating agent that reverses the action of neuromuscular blocking agents [NMBA] rocuronium and vecuronium. It is one of our institutional’ s high cost medications. As compared to neostigmine, sugammadex has lower incidence of bradycardia, post-operative nausea vomiting, and postoperative residual paralysis. The purpose of this review is to evaluate guideline reinforcement, safety & cost-effectiveness of sugammadex. Methods: This is a retrospective chart review study. IRB approval is not required by NYU-LI as this is a quality improvement project. Inclusion criteria includes patients ≥ 18 years of age received sugammadex or neostigmine in the months of July 2021 and September 2021 at NYU Langone Health Hospital Long Island. Exclusion criteria includes patients on pediatric service or receiving neostigmine for purposes other than reversal of NMBA. Results: Total of 316 patient charts were reviewed. The most common surgery service to utilize sugammadex was gastroenterology. The median dose of sugammadex was 200mg. The guideline reinforcement resulted in the following: ​reduction of non-adherent dosing from 30% to 20%, which is equivalent to $20,000 reduction in cost from Fiscal Quarter 4 2021 (June, July, & August) to Fiscal Quarter 1 2022 (September, October, November). No differences were observed in time to clinical outcomes including NMBA reversal in operating room or PACU exit, and extubation; time under anesthesia, and OR/PACU times between sugammadex and neostigmine patients. Train of Four (TOF) documentation only occurred in 41% of the patient cases. Conclusions: Education is needed to reinforce sugammadex prescribing guideline. Train of four documentation is lacking in most cases.