Effects of Electrolyte Replacement Protocol Implementation in a Medical Intensive Care Unit

Purpose: To evaluate the effects of electrolyte replacement protocol (ERP) implementation in the medical intensive care unit (MICU) setting. We hypothesized that a protocol would reduce the time of replacement dose administration and increase provider satisfaction with the process of electrolyte replacement. Methods: This was a retrospective review of electronic medical record data before and after implementation of a standardized ERP in an 18-bed military tertiary care MICU. Results: Median time from abnormal laboratory result to time of documented dose administration for potassium decreased from 180 to 98 minutes (P <.01), phosphorus decreased from 190 to 135 minutes (P <.01), calcium decreased from 95 to 61 minutes (P <.01), and magnesium decreased from 155 to 149 minutes (P <.01). Overall, there was a significant reduction in time to electrolyte repletion from 146 to 98 minutes (P <.01) for all electrolytes. Nursing satisfaction for autonomy, timeliness, effectiveness, and the need to seek orders was all improved (P <.01), and physicians saved 4.4 minutes/patient/day (P =.04). Conclusions: Electrolyte replacement protocols can be safely implemented in the MICU and reduce the time from abnormal laboratory result to electrolyte replacement dose administration. They can improve provider satisfaction and reduce physician time with the process of electrolyte replacement.