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

Electrolyte abnormalities occur often in critically ill patients with cancer. Correction of these abnormalities improves patient outcomes. Administration of intravenous electrolytes is associated with risks. Order sets have been implemented to improve standardization, timeliness of administration, and patient safety.

At a large academic cancer center, a nurse-driven central venous catheter intravenous electrolyte replacement order set was available in the intensive care unit, but adherence and barriers to use had not been assessed. The purpose of this quality improvement project was to define the baseline adherence rate to the electrolyte replacement order set.

A retrospective medical record review was conducted of medical intensive care unit patients with an active intravenous electrolyte replacement order set. All intravenous electrolytes administered within the first 72 hours of the intensive care unit stay were assessed for order set adherence.

The order set adherence rate was 78.5%. The mean turnaround time from laboratory result to electrolyte administration was 3.1 hours. Deviations were predominantly characterized by administration of a lower electrolyte dose than indicated by the order set and administration of the incorrect electrolyte salt form.

The intensive care unit intravenous order set adherence rate revealed issues with administration of potassium, magnesium, and phosphate. In response, the interprofessional intensive care unit team implemented an electronic health record feature that displays the most recent electrolyte laboratory result for nurse review before electrolyte administration.