Parenteral calcium for intensive care unit patients

Forsythe, Raquel M.; Wessel, Charles B.; Billiar, Timothy R.; Angus, Derek C.; Rosengart, Matthew R.

doi:10.1002/14651858.cd006163.pub2

Cited by 59 publications

(49 citation statements)

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“…A recent publication reviewed the topic of administering calcium for hypocalcemia in critically ill patients and concluded that there was a lack of evidence that parenteral calcium supplementation impacts the outcome of critically ill patients (18 ).…”

Section: Recently Published Reviewmentioning

confidence: 99%

Reducing Routine Ionized Calcium Measurement

et al. 2009

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Section: Recently Published Reviewmentioning

confidence: 99%

Reducing Routine Ionized Calcium Measurement

et al. 2009

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“…Indeed, this controversial topic was highlighted in a prior Cochrane systematic review examining the effects of calcium supplementation in intensive care unit (ICU) patients. 1 Additional concerns related to iCa monitoring are the increased cost and laboratory resource utilization compared with total calcium monitoring. 2,3 In the absence of evidence to support routine iCa monitoring, we sought to characterize clinicians' ordering practices among several hospital internal medicine (HIM) services in a large academic medical center.…”

Section: Introductionmentioning

confidence: 99%

Intervention to Reduce Inappropriate Ionized Calcium Ordering Practices: A Quality-Improvement Project

Newman

Siontis

Chandrasekaran

et al. 2015

TPJ

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Context:The importance of an abnormal ionized calcium (iCa) measurement in noncritically ill patients is unclear. Furthermore, iCa monitoring is more expensive than measurement of total calcium and consumes more laboratory resources. We hypothesize that most iCa tests are ordered for routine monitoring in asymptomatic patients, and results do not influence clinical management.Objective: To characterize and to intervene on iCa testordering practices among our institution's hospital-based internal medicine clinicians.Design: A quality-improvement project, with retrospective review of clinical records. We retrospectively identified the first 100 consecutive patients admitted to our hospital internal medicine (HIM) services during January 2012 with an iCa test ordered during their hospitalization. We reviewed clinical records to determine the appropriateness of iCa test ordering and of the ordering department. An educational intervention regarding the appropriateness of iCa testing was undertaken targeting HIM clinicians.Main Outcome Measures: The effect of the intervention was assessed by identifying a sample of the first 100 consecutive patients admitted to HIM services during November 2012 and by comparing the proportion of iCa tests ordered by HIM clinicians before and after the intervention.Results: HIM services were responsible for 38% of iCa measurements before the educational intervention, with the remainder originating primarily from the Emergency Department (29%) and intensive care units (28%). After the intervention, the internal medicine services were responsible for 13% of iCa measurements, which represented a 66% reduction (p = 0.0007).Conclusion: A simple intervention based on clinician education can reduce the frequency of routine iCa monitoring in stable hospitalized patients. 50The Permanente Journal/ Winter 2015/ Volume 19 No. 1 ORIGINAL RESEARCH & CONTRIBUTIONSIntervention to Reduce Inappropriate Ionized Calcium Ordering Practices: A Quality-Improvement Project the EMR looking for explicit comments by the HIM clinicians regarding the iCa indication. If no such comment was recorded in the HIM admission or progress notes, the EMR was then reviewed for active and/or historic medical conditions that might warrant iCa assessment (see Sidebar: Clinical Scenarios Generally Regarded to Warrant Ionized Calcium Monitoring) on the basis of available data and expert clinical opinion. 4,5 In situations where the indication for ordering an iCa test was in question, the two authors jointly reviewed the record to determine the indication. If a medical indication for iCa monitoring was not found, we considered this to be "inappropriate" ordering. We then quantitated the total number of iCa measurements and categorized them according to ordering department. We documented the ordering patterns in the ED and ICUs, but no intervention was performed in these departments and we did not interact with those groups.A root-cause analysis indicated that lack of clinician awareness regarding the indications of iCa t...

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“…Although hypocalcemia is common in septic and critically ill patients, it may result from a shift of calcium to the intracellular compartment and indicate disease severity without directly contributing to patient outcome (7 ). Furthermore, in critically ill patients with iCa values over 4.0 mg/dL (1.0 mmol/L), supplementation has not been shown to improve outcome (8 ). Repeat testing of iCa therefore may lead to more unnecessary supplementation, which leads to more repeat testing.…”

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confidence: 99%