Abstract
Calcitonin injection is a high-cost medication used to treat hypercalcemia in hospitalized patients. Many institutions have implemented strategies to reduce unnecessary use or waste of calcitonin, including dose rounding, formulary restriction criteria, and limiting the number of doses a patient may receive. MD Anderson Cancer Center (MDACC) utilizes approximately 1200 calcitonin doses per year with no current formulary or dosing restriction criteria. The goal of this study was to evaluate patterns of use of calcitonin at MDACC and implement and evaluate the impact of clinical decision support tools to reduce unnecessary calcitonin use and waste. This is a single-center quality improvement study comparing calcitonin utilization in a pre-intervention cohort of patients initiated on calcitonin from January 1 to April 30, 2024, to a post-intervention cohort from September 18 to October 18, 2024. Calcitonin utilization was quantified by inpatient administration data and retrospective chart review. After evaluating patterns of use in the pre-intervention data, 3 interventions were identified and implemented as clinical decision support tools in the electronic health record. These included calcitonin dose rounding, implementation of an institutional hypercalcemia treatment algorithm recommending use of calcitonin only for severe hypercalcemia, and order directions for calcitonin recommending a 48-hour limit per treatment course. The primary outcome was a composite of total percentage of calcitonin vials administered that were unnecessary or wasted defined as administrations past 48 hours, second vial administered for a dose of 401 to 500 units, or administrations to patients without severe hypercalcemia. Each item was additionally evaluated individually as a secondary outcome. The total calcitonin vials administered that were unnecessary or wasted was 6.70% lower in the post-intervention cohort than the pre-intervention cohort (P = .151). After the implementation of order directions recommending limiting calcitonin to 48 hours per treatment course, usage of calcitonin past 48 hours was significantly lower, by 5.62% (P = .035). With the implementation of a dose standardization rounding protocol, usage of a second calcitonin vial for a dose between 401 to 500 units was significantly lower, by 5.43% (P = .004). After the introduction of an institutional hypercalcemia treatment algorithm, vials used for non-severe hypercalcemia were 2.87% lower (P = .612). These findings suggest that the implementation of clinical decision support tools in the electronic health record may reduce unnecessary calcitonin use and waste.
DOI
https://doi.org/10.52519/ACEQI.25.1.2.a8
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Recommended Citation
Jordanov P, Crouch A, Towers W. Impact of Clinical Decision Support Tool Implementation on Injectable Calcitonin Usage. Advances in Cancer Education and Quality Improvement. 2025; 1(2). doi: https://doi.org/10.52519/ACEQI.25.1.2.a8.