Publication Date


Degree Awarded Date

December 22, 2022



Background and Review of Literature: The current state of practice surrounding non-depolarizing neuromuscular blocking drug monitoring is variable among practitioners and poses a safety risk to patients who may subsequently experience residual neuromuscular blockade and complications. The literature supports that train-of-four ratio monitoring, with an emphasis on use prior to extubation, is superior to other techniques and reduces the occurrence of complications related to residual neuromuscular blockade, improving patient safety and outcomes.

Purpose: The purpose of the project was to determine if an education intervention founded on evidence-based neuromuscular monitoring leads to increased use of train-of-four ratio in practitioner practice as well as improved knowledge and confidence in monitoring techniques.

Methods: A pre-intervention-post-intervention design was conducted with an educational intervention in participants from a local anesthesia group in the metropolitan St. Louis area. Retrospective electronic health record extraction was used to assess train-of-four ratio rate of use.

Implementation Plan/Procedure: A pre-recorded asynchronous powerpoint lecture was presented as the educational intervention. Word document surveys were emailed to participants the week immediately prior to education, the week immediately following intervention, thirty-day and sixty-day post-intervention to assess impact.

Implications/Conclusion: Study participants gained new knowledge evidenced by survey mean scores pre-intervention vs. post-intervention. There was not an increase in train-of-four ratio monitoring rate according to the electronic health record data. A pre-recorded education is a practical way to present evidence-based education to increase knowledge of neuromuscular monitoring among practitioners.


English (en)

Document Type



Henrichs, Bernadette PhD, CRNA, CCRN, CHSE, FAANA (Chair) Barnes Jewish College, Goldfarb School of Nursing

Associated Committee

Bisch, Abby DNP, CRNA (Committee Member) Washington University School of Medicine in St. Louis

Included in

Nursing Commons