SHM Converge Scientific Abstract ePoster Gallery-The O.K. Guidelines: Assessing a Non-Icu Evidence-Based Potassium/Magnesium Repletion Orderset

Pdf Summary

This document summarizes a quality-improvement project at Thomas Jefferson University Hospital to update and evaluate an evidence-based potassium (K) and magnesium (Mg) replacement guideline and order set for non-ICU patients.<br /><br />The team reviewed the literature and redesigned the protocol to better support safe oral (PO) and intravenous (IV) electrolyte replacement, including renal dose adjustment, route/formulation recommendations, telemetry and nephrology guidance, and clear exclusions. They also used behavioral “nudge” strategies in the order set to reduce provider cognitive load and increase use of the preferred evidence-based approach. Prior work had already increased order-set use and PO dosing.<br /><br />To assess effectiveness, 400 patients were manually reviewed before and after implementation, examining whether repletion brought electrolyte levels within normal limits, to goal, and above telemetry thresholds recommended by the American Heart Association.<br /><br />Results showed significant improvement after guideline implementation. Potassium repletion within normal limits increased from 58.3% to 79.0%, and magnesium from 75.0% to 91.5%. The proportion of patients needing telemetry after repletion fell from 7.3% to 2.3%. Route-specific improvements also trended upward for both PO and IV dosing. There were no over-repletion events or rescue medication needs.<br /><br />Extrapolated annual benefits included fewer patients exposed to arrhythmia risk, fewer unnecessary IV doses, reduced telemetry use, and substantial cost savings in medication and monitoring. The authors conclude that the guideline and order set improved repletion efficacy, safety, and value, and suggest that other institutions adopt similar approaches.

Asset Subtitle

Alan Kubey

Meta Tag

Author List Alan Kubey, Dana Jordan, Jeffrey M. Riggio, Joshua Riley

Category Research

Concept Potassium

Concept Magnesium

Concept Electrolyte Repletion

Concept Guideline

Concept Oral Dosing

Distinguished Non-Finalist

Presenter Organization Thomas Jefferson University Hospital

Presenting Author Alan Kubey

Track Quality Improvement

Keywords

potassium replacement

magnesium replacement

quality improvement

order set

evidence-based guideline

non-ICU patients

oral and intravenous repletion

telemetry reduction

electrolyte management

hospital protocol

Potassium

Magnesium

Electrolyte Repletion

Guideline

Oral Dosing