Department of Pharmacy, Grady Health System, Atlanta, GA.
Am J Health Syst Pharm. 2020 Mar 24;77(7):546-551. doi: 10.1093/ajhp/zxaa014.
Evaluation of mechanisms used to cope with an i.v. fluid shortage to determine if prescribing habits were changed and if substitution of an i.v. dose of magnesium with an oral dose impacted patient outcomes.
A single-center, retrospective analysis of electronic medical record (EMR) alerts and medical records covering 6-month periods before and during an i.v. fluid shortage was conducted. Records of adult medical and surgical inpatients admitted during these periods who had an order for i.v. or oral magnesium were screened for inclusion. The primary outcome of part 1 of the study was the percent acceptance of drug shortage-related EMR alert recommendations associated with i.v. magnesium. The primary outcome of part 2 of the study was the change in serum magnesium concentration (SMC) after an i.v. or oral dose of magnesium was administered.
Of the 7,476 EMR alerts generated during provider ordering of i.v. magnesium products, 4.8% resulted in the provider accepting the recommendation to switch to an oral alternative, 89% resulted in continuation of an i.v. magnesium order, and 6.2% resulted in order cancellation. Among patients who received magnesium doses, SMC values increased by a mean (SD) of 0.135 (0.08) mg/dL per gram of i.v. magnesium sulfate administered (n = 251), compared to an increase of 0.058 (0.08) mg/dL per 400-mg tablet of magnesium oxide administered (n = 42).
Acceptance of the EMR alert recommendations was low. Both i.v. magnesium sulfate and oral magnesium oxide are viable options for increasing SMC.
评估应对静脉补液短缺的机制，以确定是否改变了处方习惯，以及是否用口服剂量替代静脉剂量会影响患者结局。
对电子病历（EMR）警报和覆盖静脉补液短缺前后 6 个月的病历进行了单中心回顾性分析。筛选了在此期间接受静脉或口服镁治疗的成年内科和外科住院患者的记录，以确定是否纳入研究。该研究第一部分的主要结局是接受与静脉镁相关的 EMR 警报建议的药物短缺相关百分比，第二部分的主要结局是静脉或口服镁剂量后血清镁浓度（SMC）的变化。
在开具静脉镁产品期间，共生成了 7476 次 EMR 警报，其中 4.8%导致提供者接受了改用口服替代物的建议，89%导致继续静脉给予镁，6.2%导致取消了订单。在接受镁剂量的患者中，每给予 1 克静脉硫酸镁，SMC 值平均（SD）增加 0.135（0.08）mg/dL（n = 251），而每给予 400mg 氧化镁片剂，SMC 值增加 0.058（0.08）mg/dL（n = 42）。
接受 EMR 警报建议的比例较低。静脉硫酸镁和口服氧化镁都是增加 SMC 的可行选择。
