125 Improving management of malignant hypercalcaemia in NHSL acute hospitals

<h3>Background</h3> Hypercalcaemia is the most common metabolic disorder in people with cancer, most common in lung cancer, breast cancer and multiple myeloma. In NHS Lanarkshire it is defined as an adjusted calcium greater than 2.6mmol/l. Presentation of hypercalcaemia can be varied and often be subtle. Common symptoms include malaise, thirst, anorexia, nausea, constipation and polyuria. Severe symptoms include vomiting, ileus, delirium, seizures, drowsiness and coma. NHSL Guidelines has a guideline for management of malignant hypercalcaemia first developed in 2022, in line with national guidelines. <h3>Aim</h3> To improve management of malignant hypercalcaemia across acute sites in NHS Lanarkshire. <h3>Method</h3> A PDSA approach was undertaken. Caldicott Guardian approval was obtained for the project. We obtained a list of all high calcium results from the in-patient setting from biochemistry in the month of June 2023. We discounted any patients with non-malignant causes for hypercalcaemia, and those being managed in ICU or directly under the care of the haematology team. We reviewed the case notes of the remaining patients to determine if management followed the guidelines. We have undertaken education sessions across NHS Lanarkshire including FY1 teaching, hospital wide teaching and have circled email reminders of the guidelines and results so far. We are in the process of re-evaluating the data for July 2024- results will be available. <h3>Results</h3> 56 patients were identified as having malignant hypercalcaemia (UHM 22, UHW 20, UHH 14). Results were 38% managed in-line with guidelines. Only 45% of those who might have benefited from bisphosphonate received one. Advice from Palliative care was sought in 15% of cases, 25% should have sought specialist advice according to the guidelinebut did not. The results also showed scope for improvement in fluid prescription with only 43% of those included having appropriate IV fluids prescribed. Only 39% had their calcium rechecked at the correct interval of 5 days following treatment. <h3>Conclusion</h3> Key factors identified to improve the management of malignant hypercalcaemia include recognition and fluid prescription, use of bisphosphonate and monitoring and follow-up. We are in the process of evaluating July 2024 results to assess the impact education has had.