Electrolyte and Mineral Replacement

[kayakmary]

I have been a med/surg Nurse for nearly 20 years and have spent nearly 30 years at the bedside all together. I left nursing over a year ago because I was burnt out and very disheartened at the way things were going. My last job before accepting my present position was in a dialysis clinic which lasted for 6 years. I just recently went back to work in the hospital setting on a med/surg floor. While I am enjoying being back in the hospital setting, there is something that concerns me greatly... replacing electrolytes and minerals (K+,MgO4, Ca+, and PO4) according to a protocol. Almost every pt who is admitted to the hospital is placed on these protocols(even the pts who are known to be ESRD). I am concerned because even when the pt's lab value falls within normal perimeters, we are to give them supplemental po or IV K+ to bring their level up to 4.0. There have been instances where a pt was given supplemental K+ and their creatine wasn't checked by the nurse giving the RX.

It just seems like docs have become too agressive in treating something that may resolve on its own. The protocols give the nurse the directions to give these supplements w/o having to call the doc. I consider this playing with fire and gasoline. I would rather see the docs looking for the reason(s) why the pt's levels are low rather than trying to fix something that may not even be broken. Of course labs are drawn every day on these foks, but it just seems like maybe it's becoming a way for the hospital to make money.

[BluegrassRN]

I have not ever heard of this; I would not be comfortable giving an electrolyte "per protocol".

[mamiekay]

Our hospital's protocols take into account the patient's lab values. For instance, or potassium protocol checks not only the K+ level, but also the creatinine & whether the patient is on diuretics. It even states something to the effect, "If patients creatinine hasn't been drawn within xxx hours, order prior to completing protocol." Everyone of our protocols looks at the appropriate lab values before dosing adjustments. Also, most of the patients on our unit who are placed on protocols also have medicine on their cases so if there are extenuating circumstances, it's easy to call the IM doc & talk it over. As always, if there is a situation where you're not comfortable giving any medication, including electrolyte replacement, make the phone call.

[creo]

I have not heard of this type of protocols either. I tink that it would be difficult to treat electrolyte and mineral imbalances by following protocols keeping in mind that that are so many associated factors that can influence them (for instance, diabetes and insulin related to Potassium or hypoalbuminemia realted to hypocalcemia). Or the protocols should be very detailed and complex and this would be too complicated. These treatments should be patient specific.

[I<3H2O, BSN, RN]

I'm with MamieKay. Our protocol, which is NEW for us, does take into consideration the lab values. The only protocol we see is K+ replacement and that is only rarely that pts. are put on it. Only the hospitalist group uses this protocol.

[agent]

I'm with MamieKay. Our protocol, which is NEW for us, does take into consideration the lab values. The only protocol we see is K+ replacement and that is only rarely that pts. are put on it. Only the hospitalist group uses this protocol.

Yes it seems a hospitalist should be doing this.. too much renal issue an liability for nurses

[porterwoman]

Yikes. We use protocols in ICUs, then make sure they're d/c'ed before the patient gets transferred out to the floor. The protocols are not used outside ICUs. I agree with you that it sounds dangerous to be supplementing gen med patients per electrolyte protocols.

[brainkandy87]

We've got these protocols in place at the hospital I'm working at. It's awful. Even when the pt falls within normal ranges, we are still replacing elytes "per protocol." Luckily a few of the hospitalists are getting away from them simply because they were originally meant for CABG pts but have, somehow, spread to every pt in the hospital.

edit: oh and sorry for kicking up an old thread!

[tokmom, BSN, RN]

We have KCL and Mag protocol, and it is a standing order. The labs have to be pretty low though, like critical to hang either.

[#1ME]

We have a potassium protocol, but the MD has to sign the order to use it. At the bottom of the protocol form the MD must sign