Improving Neuromuscular Monitoring and Reducing Residual Neuromuscular Blockade Via E-learning

Study Overview
=================
Brief Summary
-----------------
To assess the impact of an e-learning course in neuromuscular monitoring on the frequency of application of objective neuromuscular monitoring for assessment of depth of neuromuscular blockade in general anaesthesia and secondarily on the incidence of residual neuromuscular blockade after anesthesia. We will collect data prospectively from 6 Danish anaesthesia departments from the time of intervention, using data from the Anaesthesia Information Management System (AIMS). Baseline data is obtained from another study based on the same data extraction procedure (NCT02914119).

Official Title
-----------------
Improving Neuromuscular Monitoring and Reducing Residual Neuromuscular Blockade Via E-learning - a Multicenter Interrupted Time Series Study (INVERT Study)

Conditions
-----------------
Neuromuscular Blockade

Intervention / Treatment
-----------------
* Other: E-learning course in neuromuscular monitoring


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Departments We will include the 6 largest anaesthesia departments in the Zealand Region of Denmark. Anaesthetists We will include the following anaesthesia personnel as anaesthetists: nurse anaesthetists in training, nurse anaesthetists, first year residents in anaesthesiology, residents in the last 4 years of training in anaesthesiology, and specialist consultants in anaesthesia. Patients We will include and collect data from all patients undergoing general anaesthesia with neuromuscular blockade in each data collection period. Patients, who are eligible more than once, i.e. undergoing general anaesthesia on more than one occasion, will be included in the analyses with a case for every general anaesthetic received. Exclusion criteria We will exclude personnel without clinical functions, i.e. administrative personnel.
Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Health Services Research
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: E-learning course<br> | Other: E-learning course in neuromuscular monitoring<br>* An e-learning course designed to assess the challenges and common problems experienced by anesthetists when monitoring the neuromuscular blockade during general anesthesia.<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Application of Objective Neuromuscular Monitoring (Acceleromyography) in Cases Receiving a Depolarizing Neuromuscular Blocking Agent (NMBA) (Succinylcholine) (Yes/no) | Number of Participants Who Received a Depolarizing Neuromuscular Blocking Agent (NMBA) (Succinylcholine) and was Monitored with Objective Neuromuscular Monitoring (Acceleromyography). Data on neuromuscular monitoring is automatically registered in the electronic patient chart when the equipment for acceleromyography is activated. | in the period from induction of anaesthesia to termination of anaesthesia, usually 2 hours | 
| Application of Objective Neuromuscular Monitoring (Acceleromyography) in Cases Receiving a Non-depolarizing NMBA (Yes/no) | Number of Participants Who Received a Non-depolarizing Neuromuscular Blocking Agent (NMBA) and was Monitored with Objective Neuromuscular Monitoring (Acceleromyography). Data on neuromuscular monitoring is automatically registered in the electronic patient chart when the equipment for acceleromyography is activated. | in the period from induction of anaesthesia to termination of anaesthesia, usually 2 hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Last Recorded Train-of-four (TOF) Ratio Before Tracheal Extubation or Removal of Supraglottic Airway Device in Patients Receiving a Non-depolarizing NMBA | The Train-of-four (TOF) ratio is the ratio of the fourth to the first muscle response after 4 stimuli at the ulnar nerve at the wrist at 2 Hz. The response is measured using acceleromyography. If the last measurement is performed before return of any muscle function, the ration can not be given. | in the period from induction of anaesthesia to termination of anaesthesia, usually 2 hours] | 
| Administration of Sugammadex in Cases Receiving a Non-depolarizing NMBA (Yes/no) | If the total dose of sugammadex in the anaesthesia information management system is > 0, the outcome is yes. | in the period from induction of anaesthesia to discharge from the post-anaesthesia care unit, usually 5 hours | 
| Administration of Neostigmine in Cases Receiving a Non-depolarizing NMBA (Yes/no) | If the total dose of neostigmine in the anaesthesia information management system is > 0, the outcome is yes. | in the period from induction of anaesthesia to discharge from the post-anaesthesia care unit, usually 5 hours | 
| Administration of More Than One Reversal Agent in Cases Receiving a Non-depolarizing NMBA (Yes/no) | If the total dose of neostigmine is bigger than (>) the first dose administered, the outcome is yes. | in the period from induction of anaesthesia to discharge from the post-anaesthesia care unit, usually 5 hours | 
| Time in Minutes From Tracheal Extubation or Removal of Supraglottic Airway Device to Discharge From Post-anaesthesia Care Unit in Cases Involving a Non-depolarizing NMBA |  | in the period from induction of anaesthesia to discharge from the post-anaesthesia care unit, usually 180 minutes | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Residual nerve blockade, Neuromuscular monitoring, Residual curarization, Neuromuscular blocking agents, E-learning, Web based learning