Introduction: Evidence-based guidelines for electrolyte replacement that safely encourage oral (PO) and/or intravenous (IV) dosing more successfully attain goal levels than standard care. However, the Thomas Jefferson University Hospital (TJUH) electrolyte replacement guidelines (JG 11-1296), approved in 2002 and last updated in 2008, provide guidance for IV repletion not PO. Between 5/2017-11/2017, TJUH dosed potassium and magnesium in a 2.30 and 4.24 IV:PO ratio, respectively. If 50% of doses were given PO, we anticipate ~$800,000 annual TJUH savings.
Methods: We created a multidisciplinary team and completed a literature review to inform the creation of updated TJUH guidelines for potassium and magnesium repletion. We attained updated guideline approval from the TJUH Pharmacy & Therapeutics Committee followed by the Medical Executive Board. We are working on an Epic order-set to ease clinician use of guideline-based therapy; an institutional Epic build “Freeze” is delaying progress. We will study the impact of updated guidelines with a pre-post design; using a two-tailed Welch’s t-test to test for significance.
Results: We hypothesize that the updated guidelines will reduce the ratio of IV:PO doses, increase the percent of patients within normal limits after repletion, decrease time to repletion, and reduce the average hospital cost for electrolyte repletion per patient/day. We additionally anticipate improved patient comfort and convenience of repletion though we will not study for significance.
Conclusion: We anticipate that the creation of an easily-accessible evidence-based TJUH electrolyte repletion guideline will improve quality of repletion and patient comfort while decreasing TJUH electrolyte repletion cost.
Recommended CitationRiley, Joshua and Kubey, MD, Alan, "Using Electrolyte Repletion Guidelines to Improve the Rate of Oral Potassium and Magnesium Delivery" (2020). Phase 1. Paper 3.