Nurse education to improve use of BIS protocol for patients on neuromuscular blocking agents: a Quality initiative

Background: Bispectral index (BIS) monitoring measured sedation levels of patients on neuromuscular blockers (NMB) in the intensive care unit (ICU) setting but monitoring lacked efficiency due to nurses’ unfamiliarity with the associated BIS protocol. Sedation effectiveness was highly dependent on nurse-related factors such as knowledge, skill, experience, and confidence. Objective: The objective of this quality improvement project was to improve ICU nurses’ level of knowledge and perception on BIS monitoring and increase the use of BIS protocol for management of patients receiving NMB agents. Methods: Educational intervention included a pretest and posttest method of evaluation. The project included theoretical and clinical sessions on NMB agents, BIS monitoring, and BIS sedation protocol. Effects were measured using the Knowledge Questionnaire (KQ) at baseline and four months after the intervention. BIS sedation protocol usage was assessed monthly from 1/1/2021 - 4/28/21. Results: N= 52 ICU nurses. Project was conducted in a large metropolitan hospital in Texas. KQ’s post-educational intervention demonstrated improvements (Mdn = 25, Range = 13[14-27]) which were higher than pre-educational levels (Mdn = 19.5, Range = 6 [21-27]; t= 16.954, p <. 001), Cohn’s d 2.35). The mean scores on BIS perceptions were higher post-education, between 4 to 6 on all five subscales. Protocol usage in January was 33.3%, February was 62.5%, March was 54.5 %, and April was 66.6 %. Conclusion: This educational intervention demonstrated effectiveness in improving overall ICU nurses’ knowledge levels. While not at 100%, this protocol demonstrated improvements over the four-month period. Continued education and newer strategies need to be adopted to achieve 100% usage.