Evaluation of Appropriate Sodium Polystyrene Sulfonate Use With a Hyperkalemia Order Set: A Pilot Study

Abstract

Background: No consensus guidelines exist to assist practitioners in the management of hyperkalemia. Sodium polystyrene sulfonate (SPS) is a common treatment option for hyperkalemia. To aid health-care professionals, a hyperkalemia order set was created at a 979-bed community teaching hospital.

Objective: The objective of this study was to determine whether use of a hyperkalemia order set is associated with appropriate use of SPS.

Methods: Orders for SPS were evaluated for appropriateness in this retrospective cohort of adult patients. Data were collected from December 1, 2015, to December 31, 2016. All orders for SPS not from an order set were randomly matched to those from the order set in a 2:1 fashion. Appropriate use was defined as potassium level >5.5 mEq/L and no contraindications to use. The primary outcome was the absolute difference in the proportion of patients with appropriate SPS use in the order set group compared to the nonorder set group.

Results: A total of 120 patients were analyzed, 40 in the order set group and 80 in the nonorder set group. Baseline characteristics were similar between the groups. Appropriate use occurred in 97.5% of order set patients compared to 60% in the nonorder set group (P < .001). Use of the order set was associated with a greater reduction in serum potassium, quicker follow-up potassium level, and lower incidence of gastrointestinal adverse effects.

Conclusions: The use of a hyperkalemia order set is associated with appropriate use of SPS. Requiring the use of the hyperkalemia order set for administration of SPS may enhance patient care and safety.

Keywords: cation-exchange resin; hyperkalemia; order set; sodium polystyrene sulfonate.