Abstract

Sugammadex is commonly used to antagonize neuromuscular blockade and has a clinically significant interaction with hormonal contraceptives by binding to plasma progesterone, reducing contraceptive efficacy and mimicking a missed dose. This case involved a healthy 21-year-old woman undergoing elective anterior cruciate ligament and medial collateral ligament repair whose only home medication was an oral contraceptive. She received midazolam prior to anesthesia assessment, limiting her ability to retain education, and counseling occurred at a suboptimal time without a support person present. Postoperative education was verbally relayed without standardized documentation or accountability. This project examined whether implementation of a standardized protocol regarding the interaction between oral contraceptives and sugammadex improves patient education, understanding of risk, and compliance. Review of current literature demonstrated a persistent gap between provider knowledge and consistent patient education, with counseling frequently inconsistently delivered, poorly documented, or provided after sedative administration. Studies report low rates of routine contraceptive assessment and postoperative counseling, increasing the risk of unintended pregnancy and reflecting system-level deficiencies. Evidence supports structured, multimodal education using verbal instruction, standardized written materials, and electronic health record prompts, which improve provider compliance, enhance patient recall, and promote accountability. Pharmacologic data confirm measurable alterations in hormone levels following sugammadex administration, reinforcing the clinical relevance of counseling. Translation to practice includes development of a standardized, interdisciplinary protocol incorporating electronic prompts, required documentation, clear discharge instructions, and staff education, with ongoing monitoring through audits and surveys to support sustained improvement in education delivery and patient safety. Standardized, system-based education improves reliability of contraceptive counseling and reduces preventable reproductive risks in patients receiving sugammadex.

Author Details

Hallianne Hobson Herndon, DNP(c), BSN RN CCRN. 6 years of nursing experience specializing in the cardiac intensive care unit. Terri M. Cahoon, DNP, CRNA

Sigma Membership

Non-member

Type

DNP Capstone Project

Format Type

Text-based Document

Study Design/Type

Case Study/Series

Research Approach

Translational Research/Evidence-based Practice

Keywords:

Sugammadex, Hormonal Contraception, Patient Education, Drug Interactions, Oral Contraceptives, Neuromuscular Blockade

Advisor

Terri M. Cahoon

Degree

DNP

Degree Grantor

Samford University

Degree Year

2026

Rights Holder

All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.

Review Type

None: Degree-based Submission

Acquisition

Proxy-submission

Date of Issue

2026-02-03

Full Text of Presentation

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Abstract.pdf (89 kB)

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