Enhancing Electrolyte Management in Hospitalised Older Adults Through the Integration of a Trust-Specific Electronic Prescribing

Introduction:

Electrolyte disturbances are common among older inpatients and are associated with increased risks of delirium, falls, cardiac arrhythmias, and prolonged hospital stays. Despite their prevalence and impact, local guidance for managing these imbalances is often lacking or inconsistently applied. At Rotherham NHS Foundation Trust, no standardised guideline existed for adult electrolyte correction, which disproportionately affected the older inpatient population.

To improve the timely and accurate management of electrolyte derangements—particularly in older adults—by implementing a trust-specific, evidence-based guideline embedded into the electronic prescribing system (MediTech), aiming to:

• Reduce the average number of days electrolytes remain deranged
• Improve adherence to appropriate correction protocols
• Promote safer, standardised care for older patients

Methods:

The guideline, developed collaboratively with the pharmacy, clinical governance, and EPR coding teams, was integrated into MediTech, allowing keyword-based access at the point of prescribing. Data was collected across two six-week cycles. Outcome measures included the average number of days electrolytes remained deranged, the percentage of patients with deranged electrolytes, and adherence to guideline-based prescribing.

Results:

• Cycle 1 (Mar–Apr 2024): Median days of electrolyte derangement reduced from 6.25 (pre-guideline) to 4.31 days (31% reduction). Correct prescribing increased from baseline to 60.1%.
• Cycle 2 (Nov 2024–Jan 2025): Median days further reduced to 3.04 (29.5% reduction from Cycle 1), and correct prescribing rose to 81.8%. The proportion of patients presenting with deranged electrolytes remained stable (~33–36%), likely reflecting acute admissions.

Conclusion:

Embedding a trust-specific electrolyte guideline within the electronic prescribing system significantly improved electrolyte correction in hospitalised patients, with particular benefit to older adults who are at increased risk from delayed or inappropriate treatment. Sustained improvements in prescribing accuracy and treatment timelines highlight the importance of system-level interventions in enhancing geriatric inpatient care. Future steps include continued prescriber education, user feedback, and annual audits to maintain progress.