A High-Value Care Initiative to Reduce the Use of Intravenous Magnesium Sulfate Through an Electronic Indication-Based Order Set

Background: Intravenous (IV) magnesium sulfate (MgSO₄) supplementation is common despite limited indications. Oral magnesium oxide (MgO) is an effective, lower-cost alternative. This project aimed to reduce IV MgSO₄ use by 20% among the Internal Medicine (IM) service. Methods: Electronic health record (EHR) orders for MgSO₄ and MgO within the IM service were replaced with an indication-based EHR order panel. The project team educated clinicians regarding indications for IV MgSO₄ and relative costs. The mean of daily 2 g MgSO₄ administrations per week and the mean of weekly proportion of 2 g MgSO₄ administrations nine months before and after intervention were compared between IM and Emergency Medicine (EM) (control group). Statistical process control analysis was used to assess for special cause variation in daily MgSO₄ per week and weekly proportion of MgSO₄ administrations. Results: The mean of daily 2 g IV MgSO₄ administrations per week decreased among IM (19.3 vs. 12.1, p < 0.0001) but not EM (3.1 vs. 4.8, p < 0.0001). The mean of weekly proportions of IV MgSO₄ administrations decreased among both IM (83.6% vs. 60.7%, p < 0.0001) and EM (97.0% vs. 93.1%, p = 0.0004). For IM, the change in daily MgSO₄ per week and weekly proportion of MgSO₄ occurred as a discrete initial decline consistent with special cause variation; for EM, changes in both measures were not consistent with special cause variation. Conclusion: Replacing stand-alone IV MgSO₄ orders with an indication-based order panel along with clinician education reduced IV MgSO₄ administrations and may offer a significant opportunity to reduce low-value care.