Insufficient recovery from non-depolarizing neuromuscular blocking agents results in impaired pulmonary and upper airway mechanics and increases patients’ risk of experiencing adverse respiratory events postoperatively (Kheterpal et al., 2020; Rudolph et al., 2018a; Leslie et al., 2021; Saager et al., 2019). Postoperative pulmonary complications (PPCs) are associated with an increase in hospital length of stay, rate of readmission, and overall morbidity and mortality (Kheterpal et al., 2020). The incidence of residual neuromuscular blockade following general anesthesia remains as high as 60% despite the standard use of anticholinesterase reversal agents (Saager et al., 2019). A quality improvement project (QI) was conducted to determine if anesthesia providers’ practices using neostigmine to antagonize neuromuscular blockade were consistent with current evidence-based clinical recommendations. A survey was distributed to all anesthesia providers at a level-1 trauma center, and data was collected anonymously over one month. While 96.1% of respondents correctly identified the mechanism of action of neostigmine, about half of these respondents failed to recognize the correct peak effect of neostigmine. The survey results also revealed significant provider variability in dosing neostigmine according to the number of twitches elicited using a peripheral nerve stimulator in the train-of-four mode. The survey results were compared to the practice guidelines identified in the literature review and analysis to describe educational opportunities surrounding neostigmine use at this facility. The survey findings and literature synthesis informed the creation of an intraoperative cognitive aid to guide the reversal of muscle paralysis using neostigmine. This QI project recommends ongoing evaluation and analysis of practice trends to promote best practices consistent with contemporary literature.