Understanding adherence and deviations in potassium replacement protocols: A mixed method study

Area of Science:

• Critical Care Medicine
• Clinical Pharmacy
• Nursing Practice

Background:

• Potassium replacement protocols are standard in ICUs to manage electrolyte balance and prevent harm.
• Variability exists in the implementation of these protocols across different intensive care units (ICUs).

Purpose of the Study:

• To investigate the relationship between potassium levels, administration, and existing replacement protocols.
• To identify factors influencing clinical decision-making regarding potassium replacement in ICUs.

Main Methods:

• An exploratory mixed-methods study combining retrospective audit of clinical data (2015-2022) and interviews with critical care nurses (2024).
• Analysis included over 10,000 patients' ICU data and 21 nurse interviews.

Main Results:

• Potassium replacement was indicated for 39.7% of results; administration occurred within 2 hours in 59.9% of these instances.
• Nurse interviews revealed decisions were influenced by patient history, condition, and consultation, with low concern for risks.
• Nurses desired clearer guidance on protocol purpose and mandatory adherence.

Conclusions:

• Protocol adherence and deviations in potassium replacement are complex, influenced by nurse autonomy and interprofessional collaboration.
• Clearer guidelines are needed on protocol "compulsoriness" or explicit conditions for using clinical judgment in potassium replacement.