BMC Med Inform Decis Mak - Implementation and evaluation of a nurse-centered computerized potassium regulation protocol in the intensive care unit--a before and after analysis.

Tópicos

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Resumo

CKGROUND: 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.

Resumo Limpo

ckground potassium disord can caus major complic must avoid critic ill patient regul potassium intens care unit icu requir potassium administr frequent blood potassium measur subsequ adjust amount potassium administr use potassium replac protocol can improv potassium regul safeti effici computer protocol appear superior paper protocol aim studi evalu computer potassium regul protocol icu improv potassium regulationmethod surgic icu bed cardiothorac icu bed tertiari academ center implement nursecent computer potassium protocol integr preexist glucos control program call grip glucos regul intens care patient implement computer protocol potassium replac physiciandriven potassium deliv continu either central venous cathet gastric duoden jejun tube everi potassium measur nurs receiv recommend potassium administr rate time next measur beforeaft studi evalu potassium regul grip attitud nurs staff toward potassium regul comput support measur questionnairesresult patient cohort consist patient implement computer potassium control number patient hypokalemia mmoll hyperkalemia mmoll record well time cours potassium level icu admiss incid hypokalemia hyperkalemia calcul median potassiumlevel similar studi period level potassium control improv incid hypokalemia decreas p hyperkalemia p nurs indic consid computer potassium control improv previous practiceconclus computer potassium control integr nursecent grip program glucos regul effect reduc preval hypo hyperkalemia icu compar physiciandriven potassium regul

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