Oral Electrolyte Replacement as Effective as IV Replacement in Adult Oncology Population
WASHINGTON, DC—Oral electrolyte replacement (OER) is as effective as intravenous (IV) replacement in the adult oncology population, research presented at the Oncology Nursing Society (ONS) 38th Annual Congress has shown.
After consistent patient and staff nurse dissatisfaction with the Hackensack University Medical Center's IV electrolyte replacement protocol—in which oncology nurses found patients may receive up to 500 mL excess fluid, causing unnecessary fluid overload—an evidence-based project was designed to determine if oral electrolyte replacement would be just as effective, reported Rebecca Martin, RN, BSN, OCN®, of the medical center in Hackensack, NJ.
The oncology nurses had also identified that IV electrolyte replacement creates a potential for phlebitis and pain associated with administration of IV potassium, both of which can lead to increased costs and lengthier admissions. Oral replacement is the safest way to treat mild-to-moderate hypokalemia, she noted, with IV potassium replacement indicated for severe hypokalemia or for those who cannot take oral medications. “For hypomagnesemia and hypophosphatemia, oral repletion is preferred in asymptomatic patients,” she added.
A multidisciplinary team comprising an oncology physician, a PharmD, an APN, a nurse educator, and a staff RN revised the original IV electrolyte protocol to include oral options. The revised order set was presented to the hospital Pharmacy Review Committee for physician approval and, once approved, a pilot study was initiated.
“Education of the nursing staff was key to the success of the pilot,” Martin noted. “Once the staff RN identified a decrease in the serum electrolyte value, they assessed the patient for the presence of nausea, vomiting, diarrhea, or mucositis. If all was negative, the nurse was able to proceed with the oral electrolyte replacement protocol.”
The study gathered data on 73 instances of use of oral electrolyte replacement that included laboratory values following replacement. Overall, staff nurse compliance was 95.9% for use of the oral electrolyte replacement protocol. For potassium, magnesium, and phosphorus, 65.4%, 58%, and 100% respectively, of the occurrences using oral electrolyte replacement met the target range for the serum level after repletion.
“When discussing the results with the project team, it was felt that this initial pilot was a success and that the oral electrolyte replacement protocol will eventually be used for all in-patient adult oncology patients, further enhancing cancer care,” Martin stated.
She added that the reason for the extremely high staff nurse compliance was that they “were ready for the change in protocol. They identified the issues originally and the project team came together because of their requests. It was a smooth transition from using the IV protocol to the oral electrolyte replacement [protocol].”
Staff nurse feedback also reported that a potassium phosphate oral replacement did not exist on the hospital's formulary; therefore, only sodium phosphate replacement was used. “This was vital information because it identified an unanticipated finding and a need to change the oral electrolyte replacement protocol,” Martin noted.
Additionally, data showed that while oral magnesium did not work as effectively for moderately low serum levels, it was successful for mildly low serum levels. This led to parameters on the oral electrolyte replacement protocol being changed, and the study will be re-piloted.