1. Appropriateness of Potassium Repletion on UCI Wards
DSR2 Cost Consciousness Project
Jennifer Curtin, PGY-2
1/29/15

2. Outline 2. Repletion goal - CCU patients vs. everyone else
1. When to replete K+
2. Repletion goal
- CCU patients vs. everyone else
3. How we are doing
4. What we could do better

3. When to Replete Indications for repletion:
- symptomatic or significantly low K+
- ongoing losses (diarrhea, diuresis, etc.)
- acute therapy in redistributive conditions (thyrotoxicosis, etc.)
Hypokalemia usually causes symptoms when K+ is <3.0
Symptoms can include arrhythmias, EKG changes, anorexia, n/v; muscle weakness & rhabdo can occur with K+ <2.5

4. When to Replete Quest flags a potassium of <3.5-3.6 as “low”
*Of note: Most residents repleted potassium that flagged as low (</=3.5) by Quest's standards (though I didn't look at ongoing losses or presence of symptoms as this wasn't the goal of the study)

5. Repletion Goal 1. In the CCU ONLY:
There was ONE small study showing a mortality benefit in CCU patients when potassium was repleted to a level of 4.0
2. All other patients (including those with cardiac problems or complaints who are NOT in the CCU):
There are no strict goals in the guidelines, but a level above the symptomatic threshold with a little room for error ( ) would be logical, safe and cost-conscious

6. How are we doing? Study Question
What percentage of patients on UCI wards, who had potassium repleted the morning of 1/24/15, were inappropriately repleted to 3.9 or 4.0?

7. How are we doing? Methods
- Charts were reviewed in alphabetical order under each active team list until at least 1 (up to 2) patients who had potassium repleted on 1/24/15 were obtained from each team, for a total of 10 patients.
- The repletion goal for each patient was calculated using the the sum of all replacement potassium ordered that morning and that morning's potassium lab value.
- Repletion to a goal of 3.5 or 3.7 was considered appropriate, any higher was considered inappropriate.

8. How are we doing? Results
33% (3/10) patients who had potassium repleted, were repleted inappropriately (to 4)

9. Confounders & Useful Further Investigation
How are we doing?
Confounders & Useful Further Investigation
Small sample size (n=10)
Consider looking more in depth on when potassium is repleted, and not just to what goal
(most repleted when it was )

10. Consider changing the flag cut-off in Quest for low K+
How could we do better?
Attending & resident brush-up instruction on when and how much to replete K+
Emphasis on the goal of 4 only applying to CCU patients, not floor patients with cardiac complaints or problems
Consider changing the flag cut-off in Quest for low K+

11. Thank You!