Hi All,

We are evaluating our current process of adding electrolyte replacement doses to 24hr supply of enteral formula in pediatric patients and are interested in the following:

1. Does your institution have pharmacy add enteral electrolyte replacements (e.g. NaCl, NaHCO3, etc) directly to 24 hour supply of formula to administer continuously? If so, what process is in place to handle appropriately?

Does anyone have a specific Nursing policy on the time frame they have to respond to a low electrolyte lab (K, Phos, Mg)?

One of the issues we have with our electrolyte (K,Mg,Phos) protocol orders is that the RNs do not act on the lab value in a timely manner. The question has come up, what exactly is a time window in which they can still act on an "old" lab value? Do you have a policy defining when the level is too "old" to act upon, do you recommend rechecking the level or getting a Physician order to proceed per the protocol despite the "age" of the level?