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04/09/19 -- injectable sodium bicarb

From: David Collette
Sent: Tuesday, April 9, 2019 8:49:30 AM
Subject: injectable sodium bicarb

At the Medical Executive Committee meeting today, it was requested that an additional criteria be added for sodium bicarb injection. Beginning immediately, IV bicarb may be used to treat patients with significant hyperkalemia (generally, K+ >6.2). This will most likely be ordered by a nephrologist, but may be ordered by a critical care specialist, ED physician, and possibly cardiology. There is no requirement that ABGs be checked before this order is verified. In general, only one dose of IV bicarb should be needed - at least until labs are checked and still show a critically elevated potassium.

A nephrologist present at MEC also said that he frequently sees bicarb drips started in patients and continued for several days, even though there is no clinical need to do so. Please scrutinize all bicarb drips closely and make sure that they are absolutely necessary. One physician proposed that we limit bicarb drips to 24 hours and require a new order every day, but that idea was tabled until we try close monitoring and physician communication to eliminate any unnecessary drips.

We are still in the midst of a sodium bicarb injection shortage and need to continue to preserve our supply for the most critical patients. Please let me know immediately if you see usage outside the P&T- and MEC- approved criteria. Thanks for your attention to this matter.

DAVID