SHM Converge Scientific Abstract ePoster Gallery-The O.K. Guidelines: Using an Evidence-Based Guideline Orderset to Improve Oral Potassium and Magnesium Repletion in Hospitalized Patients

The O.K. Guidelines: Using an Evidence-Based Guideline Orderset to Improve Oral Potassium and Magnesium Repletion in Hospitalized Patients

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This project developed and implemented an evidence-based electronic guideline and order set for potassium (K) and magnesium (Mg) repletion in hospitalized patients. The goal was to increase use of oral (PO) replacement, which is safer, more comfortable, and potentially less costly than intravenous (IV) replacement.<br /><br />A multidisciplinary team reviewed the literature and built guidelines that included renal dosing, route and formulation recommendations, telemetry and nephrology guidance, and exclusions. The team also used behavioral “nudge” principles to reduce provider burden and encourage best practices. The intervention rolled out in stages: guideline approval, posting on the intranet, release of an electronic order set, restriction of inpatient IV K/Mg orders to the order set, and later extension to the emergency department.<br /><br />In a quality check of 30 patients using the order set, repletion reached normal levels in 94% of K cases and 100% of Mg cases, with no overcorrection. PO repletion rates in this sample were 76% for K and 63% for Mg.<br /><br />A larger analysis of 152,818 inpatient K/Mg orders at Thomas Jefferson University Hospital showed that simply posting the guidelines and creating the order set had little effect. However, when IV access was restricted to the order set, PO use increased substantially. K PO repletion rose to 54% and Mg PO repletion to 34% during this period. When the order set was later extended to the emergency department, PO rates declined somewhat.<br /><br />Overall, the study suggests that limiting IV electrolyte ordering to a guided electronic order set can significantly increase oral repletion and may improve safety, comfort, and cost-effectiveness without compromising correction success.

Asset Subtitle

Alan Kubey

Meta Tag

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

Category Innovations

Concept Guideline

Concept Electrolyte Replacement

Concept Potassium

Concept Magnesium

Concept Oral Repletion

Distinguished Non-Finalist

Presenter Organization Thomas Jefferson University and Mayo Clinic

Presenting Author Alan Kubey

Track Quality Improvement

Keywords

potassium repletion

magnesium repletion

electronic order set

oral replacement

intravenous replacement

hospitalized patients

evidence-based guideline

electrolyte management

clinical decision support

quality improvement

Guideline

Electrolyte Replacement

Potassium

Magnesium

Oral Repletion