Correcting Magnesium Levels to Improve Cardiac Health in an Inpatient Psychiatry Population

BACKGROUND: Magnesium deficiency and psychotropic medications contribute to QT interval prolongation and cardiac arrhythmias. Evidence supports oral magnesium supplementation treatment following hypomagnesemia diagnosis in patients taking antipsychotic medications. Treating a mineral deficiency with oral supplementation rather than discontinuing or lowering the dosage of other medications is preferable for correcting QT interval prolongation and arrhythmias.

LOCAL PROBLEM: Magnesium levels were not routinely screened in the Senior Behavioral Unit, placing older adults at increased risk for cardiac events and delayed safe antipsychotic medication initiation or continuation. The purpose of this evidence-based practice project was to improve cardiac safety and support psychotropic medication management. The aim of the project was to screen magnesium levels in patients admitted to the unit and to treat eligible hypomagnesemia patients with supplementation.

METHODS: The Johns Hopkins Evidence-Based Practice Model guided project development and implementation. Education materials were provided to staff on magnesium deficiency, cardiac health, and antipsychotic medication therapy. The process measures evaluated screening and supplementation treatment compliance; outcome measures included changes in QT interval (improvement) and cardiac-related rapid response events.

INTERVENTIONS: All admitted patients to the unit received magnesium screening, and eligible hypomagnesemia patients received oral magnesium supplementation. The interventions included screening for magnesium levels upon admission and treatment for eligible patients with hypomagnesemia.

RESULTS: Screening improved from 31.7% at baseline to 92.2% post-implementation. All identified hypomagnesemia patients received supplementation, achieving 100% treatment compliance, with normalization of prolonged QT intervals noted with reduced need for higher level of care, and improved psychotropic medication administration safety.

CONCLUSIONS: Magnesium screening and treatment of hypomagnesemia were low-cost and sustainable evidence-based practice changes to improve cardiac health and enhance safety in psychotropic medication administration for senior adult patients. Sustainability is supported by the permanent integration of magnesium screening into the unit’s electronic admission order set, to sustain ongoing cardiac health and optimal psychotropic medication management.