Semester

Summer

Date of Graduation

2025

Document Type

Dissertation

Degree Type

DNP

College

School of Nursing

Department

Anesthesiology

Committee Chair

Aaron Ostrowski

Committee Co-Chair

Jessica Poole

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's 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.

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