Problem Statement—Research has demonstrated that ensuring a train-of-four ratio (TOFR) >
0.9 with an objective neuromuscular monitor is the safest practice to prevent residual
neuromuscular blockade (RNMB). Unfortunately, the traditional practice of subjective
neuromuscular monitoring and clinical bedside tests has not reduced the incidence of RNMB
from where it was in 1979. Marion General Hospital (MGH) in Marion, Indiana, has an objective
neuromuscular monitor in every operating room. However, none of the anesthesia providers
utilize the objective monitors due to a perception of inaccuracy and increased complexity.
Purpose—The project aimed to increase the perceptions, understanding, and likelihood of using
the objective neuromuscular monitor amongst anesthesia providers. Method—A pretest,
educational intervention, and post-test were administered, followed by a hands-on demonstration
of the objective neuromuscular monitors. The data was analyzed to find percentage change.
Results—89% of pre-and post-intervention providers believed RNMB to be a significant clinical
problem. Two-thirds (67%) of anesthesia providers always monitor neuromuscular function
using subjective or objective monitoring. There was an 11% decrease (78% to 67%) following
the intervention in participants' belief that objective neuromuscular monitors would reduce
RNMB. Implications— As EMG technology becomes more portable and user-friendly, more
anesthesia department heads will likely purchase these devices. New EMG monitors such as the
TwitchView® Train of Four Monitor could be an objective monitor able to overcome these
barriers in practice. Keywords used as search terms were residual curarization, residual
neuromuscular blockade, postoperative pulmonary complications, critical respiratory events,
quantitative neuromuscular monitors, and peripheral nerve stimulators.