Reducing Hypoglycemia from Treatment of Hyperkalemia
A Rush Multi-Site EBP Project
Joshua Kautz, MSN, RN, CMSRN, Melody Kwan, RN, CCRN, Erin Dowding, MSN, APN, ACNS-BC, OCN, and Mary Heitschmidt, PhD, APN, CCRN
Joshua Kautz, an RN2 on Rush University Medical Center’s (RUMC) 7 South Atrium Medical-Surgical unit, experienced several near miss and actual patient hypoglycemia safety events when implementing orders and guiding peers to give IV push insulin with glucose support to treat hyperkalemia.
Josh Kautz analyzed the complex multi-step protocol, evaluated the literature, and proposed solutions to improve care. Melody Kwan, an RN3 on Rush Oak Park Hospital’s (ROPH) intensive care unit, was concurrently seeking to improve the hyperkalemia treatment order set at ROPH.
Project sponsors Erin Dowding, Clinical Nurse Specialist and Mary Heitschmidt, Director of Clinical Research, connected the clinical nurses to create a hospital system intervention for the problem. Pre-data and a literature search confirmed there were opportunities to change practice at both sites. Josh Kautz and Melody Kwan were awarded a 2017 Center for Clinical Research and Scholarship Grant for their hyperkalemia project.
The goal of this project was to improve patient safety and align the hyperkalemia treatment order set with evidenced-based practice and research performed years ago at RUMC.
During the three-month pre and post data collection periods, RUMC collected data from the first 20 administrations of IV insulin each month. Data from every IV push regular insulin administration from ROPH were collected and included in the analysis. Data collection methods were different due to the estimated number of hyperkalemic events at each site.
On Oct. 9, 2017, Josh Kautz and Melody Kwan presented the pre data results from RUMC and ROPH at a multidisciplinary hyperkalemia meeting. With multidisciplinary support from pharmacy, nephrology, and general medicine at both institutions, they devised an improved order set and a nursing clinical resource to meet the project goals.
RUMC implemented the new order set Nov. 27, 2017, while ROPH went live on Feb. 14, 2018. Three months of post-intervention data were assessed from the two hospitals. Final data collection was completed on Feb. 19, 2018 at RUMC and May 31, 2018 at ROPH.
The combined rate of hypoglycemic events per IV push insulin treatment was reduced from 0.298 in 2017 pre data to 0.114 in 2018 post data, a 61.7 percent reduction showing a significant impact of improvements made towards care of hyperkalemia with insulin. The hyperkalemia team is working on internal and external dissemination of their project results.