title: Implementation and evaluation of a nurse-centered computerized potassium regulation protocol in the intensive care unit--a before and after analysis.
abstract: 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.
authors.affiliation: Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. m.hoekstra@thorax.umcg.nl
authors.forename: Miriam
authors.initials: M
authors.lastname: Hoekstra
authors.forename: Mathijs
authors.initials: M
authors.lastname: Vogelzang
authors.forename: José T
authors.initials: JT
authors.lastname: Drost
authors.forename: Marcel
authors.initials: M
authors.lastname: Janse
authors.forename: Bert G
authors.initials: BG
authors.lastname: Loef
authors.forename: Iwan C C
authors.initials: IC
authors.lastname: van der Horst
authors.forename: Felix
authors.initials: F
authors.lastname: Zijlstra
authors.forename: Maarten W N
authors.initials: MW
authors.lastname: Nijsten
mesh_terms: D001786:Blood Glucose; D002985:Clinical Protocols; D015331:Cohort Studies; D020000:Decision Support Systems, Clinical; D006801:Humans; D007008:Hypokalemia / Q000451:nursing / Q000517:prevention & control*; D007328:Insulin / Q000008:administration & dosage; D007362:Intensive Care Units; D009741:Nursing Staff, Hospital; D019095:Point-of-Care Systems; D011182:Postoperative Care; D011188:Potassium / Q000097:blood*; D011795:Surveys and Questionnaires; D018511:Systems Integration; D013813:Therapy, Computer-Assisted; D000078329:Workforce
chemical_list: D001786:Blood Glucose; D007328:Insulin; D011188:Potassium