Date of Award

Fall 2020

Degree Type

Dissertation/Thesis

Degree Name

Doctor of Nursing Practice (DNP)

School

Leadership and Advanced Nursing Practice

Committee Chair

Dr. Nina McLain

Committee Chair School

Leadership and Advanced Nursing Practice

Committee Member 2

Dr. Stephanie Parks

Committee Member 2 School

Leadership and Advanced Nursing Practice

Abstract

As the cost of health care continues to rise and insurance reimbursements have decreased, organizations have to find avenues to cut costs and increase profits. A goal of this project is to help prepare anesthesia providers with the best evidence-based knowledge about sugammadex and neostigmine and allow providers to make a sound, cost-efficient decision when choosing a reversal method. A needs assessment was conducted with the chief certified registered nurse anesthetist (CRNA) at a north delta Mississippi facility. The needs assessment demonstrated that cost was the main concern and reason for choosing neostigmine over sugammadex. Further, providers at the chosen hospital also wanted to know whether the benefits of sugammadex outweighed the cost of the medication.

A thorough literature review and detailed cost analysis indicated that sugammadex is a superior reversal agent for reversing the paralytic effects of rocuronium and could create a cost-effective surgical care model if implemented fully into clinical practice. The cost-benefit analysis of neostigmine versus sugammadex demonstrated that the purchasing price of sugammadex was more expensive than the cost of neostigmine, but a thorough literature review and detailed cost analysis indicated that sugammadex could potentially have a cost savings of $345,640 to $997,064 over a 6-month period by increasing the rate of discharge from the operating room. Sugammadex has a purchasing cost of $70.72, and if this reversal technique was used for each of the 800 abdominal surgical cases over the 6-month period, the overall purchasing cost would be $48,360.

Implementing sugammadex into clinical practice could have a potential cost savings of $345,640 at minimum over a 6-month period after the purchasing cost of sugammadex is considered and will drastically improve patient outcomes by preventing residual muscle paralysis from incomplete reversal of paralysis. An evidence-based literature review and a detailed cost analysis demonstrated that sugammadex is far superior in reversing the effects of rocuronium and can allow operating rooms to save a tremendous amount of money by improving operating room discharge times, which would offset the purchasing cost of sugammadex and create an efficient surgical care model.

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