Key result
Nurse-centered computerized potassium regulation is linked to ~38% lower hyperkalemia odds vs physician-driven care.
Why the study?
Potassium disorders cause major complications in critically ill patients and require effective regulation in the ICU, but the impact of computerized potassium protocols was unclear.
Does a nurse-centered computerized potassium regulation protocol reduce the incidence of hypokalemia and hyperkalemia in ICU patients compared to physician-driven management?
Observational (n=2,210)
No
Does a nurse-centered computerized potassium regulation protocol reduce the incidence of hypokalemia and hyperkalemia in ICU patients compared to physician-driven management?
Implementation of a nurse-centered computerized potassium regulation protocol significantly reduced the incidence of both hypokalemia and hyperkalemia in the ICU compared to standard physician-driven management.
Should not yet change ICU potassium management; leaves open need for randomized confirmation of benefit.
BACKGROUND: Potassium disorders can cause major complications and must be avoided in critically ill patients. Regulation of potassium in the intensive care unit (ICU) requires potassium administration with frequent blood potassium measurements and subsequent adjustments of the amount of potassium administrated. The use of a potassium replacement protocol can improve potassium regulation. For safety and efficiency, computerized protocols appear to be superior over paper protocols. The aim of this study was to evaluate if a computerized potassium regulation protocol in the ICU improved potassium regulation. METHODS: In our surgical ICU (12 beds) and cardiothoracic ICU (14 beds) at a tertiary academic center, we implemented a nurse-centered computerized potassium protocol integrated with the pre-existent glucose control program called GRIP (Glucose Regulation in Intensive Care patients). Before implementation of the computerized protocol, potassium replacement was physician-driven. Potassium was delivered continuously either by central venous catheter or by gastric, duodenal or jejunal tube. After every potassium measurement, nurses received a recommendation for the potassium administration rate and the time to the next measurement. In this before-after study we evaluated potassium regulation with GRIP. The attitude of the nursing staff towards potassium regulation with computer support was measured with questionnaires. RESULTS: The patient cohort consisted of 775 patients before and 1435 after the implementation of computerized potassium control. The number of patients with hypokalemia (<3.5 mmol/L) and hyperkalemia (>5.0 mmol/L) were recorded, as well as the time course of potassium levels after ICU admission. The incidence of hypokalemia and hyperkalemia was calculated. Median potassium-levels were similar in both study periods, but the level of potassium control improved: the incidence of hypokalemia decreased from 2.4% to 1.7% (P < 0.001) and hyperkalemia from 7.4% to 4.8% (P < 0.001). Nurses indicated that they considered computerized potassium control an improvement over previous practice. CONCLUSIONS: Computerized potassium control, integrated with the nurse-centered GRIP program for glucose regulation, is effective and reduces the prevalence of hypo- and hyperkalemia in the ICU compared with physician-driven potassium regulation.
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Hoekstra et al. (2010) conducted an observational in Critically ill patients requiring intensive care (n=2,210). Computerized potassium regulation protocol (GRIP-II) vs. Physician-driven potassium regulation was evaluated on Incidence of hyperkalemia (>5.0 mmol/L) (OR 1.6, 95% CI 1.5-1.7, p=<0.001). Implementation of a nurse-centered computerized potassium regulation protocol reduced the incidence of hyperkalemia from 7.4% to 4.8% (OR 1.6) and hypokalemia from 2.4% to 1.7% compared to physician-driven regulation.
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