Implementation and evaluation of a nurse-centered computerized potassium regulation protocol in the intensive care unit - a before and after analysis

Abstract

BackgroundPotassium disorders can cause major complications and must be avoided in critically ill patients. Regulation of potassium in the intensive care unit (ICU) requires potassium administration with frequent blood potassium measurements and subsequent adjustments of the amount of potassium administrated. The use of a potassium replacement protocol can improve potassium regulation. For safety and efficiency, computerized protocols appear to be superior over paper protocols. The aim of this study was to evaluate if a computerized potassium regulation protocol in the ICU improved potassium regulation.MethodsIn our surgical ICU (12 beds) and cardiothoracic ICU (14 beds) at a tertiary academic center, we implemented a nurse-centered computerized potassium protocol integrated with the pre-existent glucose control program called GRIP (Glucose Regulation in Intensive Care patients). Before implementation of the computerized protocol, potassium replacement was physician-driven. Potassium was delivered continuously either by central venous catheter or by gastric, duodenal or jejunal tube. After every potassium measurement, nurses received a recommendation for the potassium administration rate and the time to the next measurement. In this before-after study we evaluated potassium regulation with GRIP. The attitude of the nursing staff towards potassium regulation with computer support was measured with questionnaires.ResultsThe patient cohort consisted of 775 patients before and 1435 after the implementation of computerized potassium control. The number of patients with hypokalemia (<3.5 mmol/L) and hyperkalemia (>5.0 mmol/L) were recorded, as well as the time course of potassium levels after ICU admission. The incidence of hypokalemia and hyperkalemia was calculated. Median potassium-levels were similar in both study periods, but the level of potassium control improved: the incidence of hypokalemia decreased from 2.4% to 1.7% (P < 0.001) and hyperkalemia from 7.4% to 4.8% (P < 0.001). Nurses indicated that they considered computerized potassium control an improvement over previous practice.ConclusionsComputerized potassium control, integrated with the nurse-centered GRIP program for glucose regulation, is effective and reduces the prevalence of hypo- and hyperkalemia in the ICU compared with physician-driven potassium regulation.

Systematic review of clinical decision support interventions with potential for inpatient cost reduction

“…29.5% of the studies occurred in an ICU setting [18,23,31,34-36,39,40,44,47],[51,57-59,63,65,68,73,79,82],[86,88,89], and 15.4% took place in an ED setting [13,20-22,27,29,38,45,75,81],[83,84]. …”

Potassium and Magnesium Supplementation Do Not Protect Against Atrial Fibrillation After Cardiac Operation: A Time-Matched Analysis

“…Studies of standardized potassium repletion protocols have not demonstrated a reduction in atrial tachyarrhythmias (14, 15), while multiple trials of magnesium supplementation for POAF prophylaxis have demonstrated no clear benefit (16, 17, 24). Our findings help to explain the lack of efficacy of potassium and magnesium supplementation in these other reports, in that the maintenance of near-normal electrolyte levels was not sufficient to reduce the rate of POAF.…”

“…The few existing studies of intensive care unit (ICU) electrolyte repletion protocols have demonstrated tighter control of postoperative potassium levels but no effect on the occurrence of POAF (14, 15). Intraoperative and postoperative magnesium administration has also been evaluated as an AF prophylaxis agent in many small and heterogeneous studies, with conflicting but overall limited efficacy (16, 17).…”

Evaluation of an Electrolyte Repletion Protocol for Cardiac Surgery Intensive Care Patients

“…11,12 With regard to electrolyte repletion, numerous studies have focused on the control of a single electrolyte. [13][14][15][16] To date, 4 studies have evaluated repletion protocols for multiple electrolytes in various intensive care settings. [17][18][19][20] The results of these studies have suggested that use of repletion protocols is more effective than standard approaches to electrolyte repletion.…”