Cost Savings Through Nutrition Support Team Monitoring Of Patients Receiving Amphotericin B

Abstract

Patients receiving nephrotoxic drug therapy may present with a variety of electrolyte abnormalities. Observations by the Nutrition Support Team (NST) revealed a tendency for frequent use of electrolyte boluses rather than modification of intravenous solutions or oral supplementation in patients who had amphotericin B (ampho B) therapy. Ampho B is a drug used to treat specific fungal infections in immunocompromised patients. It can cause varying degrees of nephrotoxicity in up to 80% of patients with resultant losses of potassium (K) and magnesium (Mg). Abnormally low electrolyte levels can cause mild to severe adverse effects ranging from weakness and tremors to cardiac arrhythmias. There have been 4 reported cases of reversible congestive heart failure attributed to the hypokalemia caused by ampho B. Since our NST is responsible for the management of serum electrolyte concentrations for patients receiving parenteral nutrition, the hypothesis was that these patients might need fewer electrolyte boluses. To test the hypothesis, all patients who received ampho B were monitored during a 30 day period. There were 11 patients and 93 patient days of ampho B therapy for NST and 11 patients and 71 patient days for non-NST monitored patients. Results are reported comparing patients monitored by the NST versus patients monitored by the unit team. Benefits to NST monitored patients included fewer days when serum K and Mg were lower than normal, fewer K and Mg boluses prescribed, and time savings for the nurses estimated at 18 to 85minutes. The conclusions were: 1) there were fewer days when serum electrolyte levels were below normal for patients monitored by the NST, 2) the NST reduced the number of K and Mg boluses given to correct serum levels, and 3) savings based on patient charges for boluses and connecting tubing were $279.50, which projected to an annual savings of $3,354.00 for this one drug therapy alone.