Advertisement

Sugammadex Effects on Hormonal Contraception Effectiveness: Implementation of Uniform Postoperative Teaching

      Abstract

      Purpose

      The purpose of this quality improvement project was to improve consistency of discharge teaching in women who used progesterone-containing hormonal contraceptive medications and received sugammadex during general anesthesia, as there is a risk of unintended pregnancy for 1 week after administration of sugammadex.

      Design

      This project used a predesign and postdesign using two separate sample groups of patients and postanesthesia care unit (PACU) nurses.

      Methods

      The sample consisted of 31 total women of childbearing age and 59 PACU nurses. Simplification of sugammadex discharge instructions was achieved by incorporating evidence-based recommendations for electronic discharge instructions and nursing education. PACU nurses were educated and surveyed before and after regarding frequency of discharge teaching, clarity, and comprehension of the after-visit summary and knowledge of sugammadex. Patients were called via telephone postoperatively to assess recall of sugammadex discharge teaching.

      Findings

      Postoperative patient phone calls identified a small increase in patient recall of discharge instructions from 5 of 14 patients (35.7%) before implementation to 7 of 17 after implementation (41.2%). PACU nurse surveys indicated an increase in self-reported frequency of sugammadex discharge teaching (34.8% vs 64.2%, P = .024) and that new discharge instructions contained more clear, comprehensive information as compared with previous instructions (29.4% vs 75.5%, P = .001).

      Conclusions

      This quality improvement project successfully implemented more consistent and comprehensive discharge instructions for women who receive sugammadex intraoperatively. Limitations of the project included a small sample size and short implementation intervals. As a result of switching to uniform discharge instructions, more patients received important discharge teaching from PACU nurses, and the percentage of patients who recalled this information increased.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of PeriAnesthesia Nursing
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Carron M.
        • Zarantonello F.
        • Tellaroli P.
        • Ori C.
        Efficacy and safety of sugammadex compared to neostigmine for reversal of neuromuscular blockade: a meta-analysis of randomized controlled trials.
        J Clin Anesth. 2016; 35: 1-12
        • Carron M.
        • Zarantonello F.
        • Lazzarotto N.
        • Tellaroli P.
        • Ori C.
        Role of sugammadex in accelerating postoperative discharge: A meta-analysis.
        J Clin Anesth. 2017; 39: 38-44
        • Murphy G.S.
        Residual neuromuscular blockade: incidence, assessment, and relevance in the postoperative period.
        Minerva Anestesiol. 2006; 72: 97-109
      1. Bridion [package insert]. Merck & Co., Inc., Whitehouse Station, NJ2015
        • Webber A.M.
        • Kreso M.
        Informed Consent for Sugammadex and Oral Contraceptives: Through the Looking Glass.
        Anesth Analg. 2018; 127: e52
        • Golembiewski J.
        Sugammadex.
        J Perianesth Nurs. 2016; 31: 354-357
        • Gold S.J.A.
        • Harper N.J.N.
        The place of sugammadex in anaesthesia practice.
        Trends Anaesth Crit Care. 2012; 2: 4-9
        • Mirakhur R.K.
        Sugammadex in clinical practice.
        Anaesthesia. 2009; 64: 45-54
        • Williams R.
        • Bryant H.
        Sugammadex advice for women of childbearing age.
        Anaesthesia. 2018; 73: 133-134
        • Smart A.
        • Gallagher J.
        Clinicians and women's learning package on Sugammadex (Bridion) and hormonal contraceptives.
        Aust Nurs Midwifery J. 2015; 22: 52
        • Veselis R.A.
        • Pryor K.O.
        • Reinsel R.A.
        • Li Y.
        • Mehta M.
        • Johnson Jr., R.
        Propofol and midazolam inhibit conscious memory processes very soon after encoding: an event-related potential study of familiarity and recollection in volunteers.
        Anesthesiology. 2009; 110: 295-312
        • Watson P.W.
        • McKinstry B.
        A systematic review of interventions to improve recall of medical advice in healthcare consultations.
        J R Soc Med. 2009; 102: 235-243
        • Lin R.
        • Gallagher R.
        • Spinaze M.
        • et al.
        Effect of a patient-directed discharge letter on patient understanding of their hospitalisation.
        Intern Med J. 2014; 44: 851-857
        • Griffey R.T.
        • Shin N.
        • Jones S.
        • et al.
        The impact of teach-back on comprehension of discharge instructions and satisfaction among emergency patients with limited health literacy: A randomized, controlled study.
        J Commun Healthc. 2015; 8: 10-21
        • De Oliveira Jr., G.S.
        • McCarthy R.J.
        • Wolf M.S.
        • Holl J.
        The impact of health literacy in the care of surgical patients: a qualitative systematic review.
        BMC Surg. 2015; 15 (Published 2015 Jul 17): 86
        • Jolly B.T.
        • Scott J.L.
        • Sanford S.M.
        Simplification of emergency department discharge instructions improves patient comprehension.
        Ann Emerg Med. 1995; 26: 443-446
        • Choudhry A.J.
        • Younis M.
        • Ray-Zack M.D.
        • et al.
        Enhanced readability of discharge summaries decreases provider telephone calls and patient readmissions in the posthospital setting.
        Surgery. 2019; 165: 789-794
        • Stossel L.M.
        • Segar N.
        • Gliatto P.
        • Fallar R.
        • Karani R.
        Readability of patient education materials available at the point of care.
        J Gen Intern Med. 2012; 27: 1165-1170
        • Blandford C.M.
        • Gupta B.C.
        • Montgomery J.
        • Stocker M.E.
        Ability of patients to retain and recall new information in the post-anaesthetic recovery period: a prospective clinical study in day surgery.
        Anaesthesia. 2011; 66: 1088-1092
        • El Shafie S.
        • Craik J.
        • Day A.M.
        • Desborough J.
        • Bardakos N.
        • Twyman R.
        The effects of general anaesthesia on memory recall following day-case knee arthroscopy. Ambul Surg. 2014;20:10-12.
        • About Duke University Hospital
        About Duke University Hospital | Durham, NC | Duke Health.
        • Jindal P.
        • MacDermid J.C.
        Assessing reading levels of health information: uses and limitations of flesch formula.
        Educ Health (Abingdon). 2017; 30: 84-88
        • Kincaid J.P.
        • Fishburne Jr., R.P.
        • Rogers R.L.
        • Chissom B.S.
        "Derivation Of New Readability Formulas (Automated Readability Index, Fog Count And Flesch Reading Ease Formula) For Navy Enlisted Personnel" (1975). Institute for Simulation and Training. 56.
        • Pavlik V.
        • Brown A.E.
        • Nash S.
        • Gossey J.T.
        Association of patient recall, satisfaction, and adherence to content of an electronic health record (EHR)-generated after visit summary: a randomized clinical trial.
        J Am Board Fam Med. 2014; 27: 209-218
        • Aapro M.S.
        • Walko C.M.
        Aprepitant: drug-drug interactions in perspective.
        Ann Oncol. 2010; 21: 2316-2323