Emily Robert, Michelle Alonso, and Hunter Perrin
James H. Quillen Veteran Affairs Medical Center – Mountain Home, TN
Contact Information:
[email protected]Background/Purpose: Electrolyte deficiencies are common throughout patient care and often require timely replacement to avoid adverse events. Disturbances in electrolytes are particularly important due to the potential to cause life-threatening complications such as cardiac arrhythmias, seizures, neuromuscular dysfunction, and hemodynamic instability. Despite their clinical significance, electrolyte replacement practices are often variable and provider dependent. The Institute for Safe Medication Practices (ISMP) highlights in its 2024-2025 Targeted Medication Safety Best Practices that hospitals should implement layered strategies across the entire medication-use process to improve safety with high-alert medications, including electrolytes. The purpose of this quality improvement project is to align James H. Quillen Veterans Affairs Medical Center (JHQVAMC) medication-use processes with the 2024-2025 ISMP Targeted Medication Safety Best Practice recommendations regarding high-alert medications used for electrolyte replacement therapies.
Methodology: This project aims to evaluate existing electrolyte replacement protocols and order sets, as well as develop new ones as necessary. This project also aims to ensure appropriate electrolyte replacement product utilization and storage. Accomplishing this will require evaluation of the JHQVAMC current electrolyte replacement practices, including revision of current protocols and order sets. Adjustments to current protocols and order sets will include indication, dosing, frequency, duration, and comments regarding appropriate administration and monitoring. The electrolyte protocols and order sets will be submitted for final approval by the Medication Safety Committee and Pharmacy and Therapeutics Committee. Implementation will occur in the emergency department, hematology/oncology clinic, and inpatient wards, including the intensive care unit. Targeted education will be provided by pharmacy services prior to implementation. A retrospective analysis will be conducted comparing data from a pre-implementation period (June 1, 2025 to September 1, 2025) to a post-implementation period (three months; dates to be determined). Data to be collected during pre- and post-implementation time frames will include: patients with potassium < 3.6 mEq/L or phosphorus < 2.3 mg/dL, number of electrolyte replacement order sets available within the electronic health record (EHR), number of electrolyte replacement protocols available within the EHR, potassium and phosphorus supplementation for potassium < 3.6 mEq/L or phosphorus < 2.3 mg/dL, potassium and phosphorus lab values following supplementation, and Omnicell stocking reports to determine presence of concentrated electrolyte vials intended for dilution.
Results: In progress
Conclusions: In progress
