A question that I have been unable to find an answer to at my current job about mag/k+ protocol. This protocol is ordered on everyone admitted to our ICU. Usually by the nurses as the docs themselves RARELY put in admission orders of any kind.
When you have Hemodialysis or TPN pt.s do you still follow the mag/K+ replacement protocol at your facility?
Our nutrition department writes the orders for TPN based on that morning labs and often-times when they have been replaced people do not redraw the labs and the a.m values available in the computer do not accurately reflect the pt.s current levels.
Same with hemodialysis pts. the docs often write their orders based on the morning lab values prior to redraw after replacement.
We have no policy I can find covering TPN and dialysis pts. I have asked multiple people including my manager only to be told.....yes always/no, never, and it depends. On what no one can really tell me. The docs and nutrition people are not available to me (work nights).
I ask because a few times I have had pts like this for a couple nights in a row and find their levels become elevated because no one is taking into account it was replaced (by me) that a.m. even though it is charted and I have passed it onto dayshift. I am fearful my pts. will end up with hyperkalemia/magnesmia because people often forget to redraw and the docs/nutrition people are not taking that into consideration. What I started to do is leave messages for the nutrition/hemo docs in the a.m. telling them current levels and amount of replacement and when that didn't work I started not replacing unless of course the level was very low. I would be interested to know how other facilities handle this. At my previous facility only the hemo docs or nutrition team addressed K and mag levels for these pts. but it was not an ICU.