Adherence to an Intravenous Electrolyte Replacement Order Set for Critically Ill Oncology Patients

Area of Science:

• Critical Care Medicine
• Oncology
• Pharmacology

Background:

• Electrolyte abnormalities are common in critically ill cancer patients, impacting outcomes.
• Intravenous electrolyte administration carries risks; order sets aim to standardize and improve safety.
• Assessing adherence to existing order sets is crucial for quality improvement.

Purpose of the Study:

• To determine the baseline adherence rate to a nurse-driven intravenous electrolyte replacement order set.
• To identify deviations from the order set in intensive care unit (ICU) patients.
• To inform quality improvement initiatives for electrolyte management.

Main Methods:

• Retrospective medical record review of ICU patients with an active electrolyte replacement order set.
• Assessment of all intravenous electrolytes administered within the first 72 hours of ICU stay.
• Evaluation for adherence to the established order set protocols.

Main Results:

• The overall order set adherence rate was 78.5%.
• Mean turnaround time from lab result to administration was 3.1 hours.
• Common deviations included lower electrolyte doses and incorrect salt forms.

Conclusions:

• Adherence to the ICU intravenous electrolyte order set requires improvement, particularly for potassium, magnesium, and phosphate.
• An electronic health record feature was implemented to display recent lab results for nurses.
• This aims to enhance safe and accurate electrolyte administration in critically ill cancer patients.