A nurse-driven electrolyte replacement program (ERP) for patients with hematologic malignancies improved time to electrolyte replacement and decreased cardiac arrythmias at 1 academic medical center.
Chemotherapy, nausea, vomiting, and malnutrition can all contribute to electrolyte depletion in patients being treated for hematologic malignancies. In addition, certain medications common in the treatment of these patients can further reduce electrolytes.
According to a quality and safety study published in the Clinical Journal of Oncology Nursing, before implementing a nurse-driven ERP, patient health at the University of California, Los Angeles, was tested for electrolyte levels by bedside nurses, who, if their patient’s electrolyte levels were critically low, would call the on-call provider. If the levels were not critically low, no replacement would be given prior to the nurse practitioner reviewing lab values at morning rounds. The study reported an average time of 344 minutes from lab results to electrolyte repletion.
To lessen this time and prevent electrolyte deficiency-related cardiac arrythmias, a team of advanced practice nurses designed and implemented an inpatient hematologic malignancy ERP with dosing and parameters guided by the literature. Their ERP included magnesium and potassium replacement, excluding calcium because of the possibility of false low levels of serum calcium due to low levels of albumin in these patients. Phosphorous was also excluded because of intermittent supplier shortages.
In the ERP, potassium was given either orally or via IV (if the patient could not tolerate oral potassium due to certain side effects from cancer treatment). Magnesium was only given via IV. The protocols were built into the appropriate admission order sets, and nurses, pharmacists, and other providers were educated on the protocol.
Using their electronic health record, the study team identified 60 patients admitted to the hematology-oncology service before ERP implementation (November 2019-October 2021). The average time from lab review to electrolyte repletion in this cohort was 344 minutes. The cohort had a total of 8 cardiac arrythmias due to electrolyte depletion.
Reviewing the records of patients admitted after ERP implementation (November 2021-October 2022; n=not defined), the time to electrolyte repletion decreased to an average of 112 minutes, and only 1 cardiac arrythmia was noted. This was thought to be due to concurrent cytokine release syndrome.
The report concluded, “Electrolyte abnormalities commonly occur among patients with hematologic malignancies because of chemotherapy, supportive medications, and treatment side effects. A nurse-driven, literature-based ERP can ensure safe and standardized repletion administration.”
Implementation and evaluation of an inpatient electrolyte replacement protocol for patients with hematologic malignancies.