(1297) Nurse-Led Protocolized Electrolyte Replacement in Surgical Intensive Care Unit: A Quality Initiative

Introduction: Electrolytes play a pivotal role in maintaining internal milieu by participating in various physicochemical reactions, which are vital for the balanced function of all vital systems. An audit among our intensive care patients revealed that the correction of hypokalemia, hypomagnesemia and hypophosphatemia were time consuming. Since electrolytes deficiencies are associated with increased adverse events among critically ill patients which can even lead to fatal consequences.

Methods: A task force of health care workers addressed those issues and identified the delay and ineffective replacements were primarily due to the delay in physician orders prescribed in our Electronic Medical Record and a variation in practice among the ordering physicians. We concluded that implementation of a nurse driven electrolyte replacement protocol which is activated upon patient admission in the unit, could achieve the replacement of electrolytes expeditiously and adequately. The value improvement initiative was conducted in a 15- bed SICU. The model for improvement quality methodology was used in this project. Baseline data was collected by retrospective audit of patient electronic records for 8 weeks and after multiple test of changes (PDSAs), education of the staff and support from all the stake holders, we could successfully implement the protocol for potassium, magnesium and phosphate correction.

Results: A reduction in time for the electrolyte correction from an average of 55 hours to 12 hours were achieved without any significant adverse events .By reducing the time to correction of electrolyte disturbances from 55 hours to less than 12 hours might have contributed in reducing the length of stay in ICU by 1-2 days.

Conclusions: Electrolyte disturbances are very common in any intensive care unit, which can be prevented, detected early and effectively corrected by a nurse led protocol. Addressing electrolyte imbalances early can help prevent further complications and improve overall patient outcomes. Using protocols for electrolyte correction in the ICU can improve efficiency and save time for physicians, allowing them to focus on other clinical issues. This approach has led to increased provider satisfaction as well.