Guidelines updated but evidence for specific best practices still needed
By Barbara Kermode-Scott
CALGARY | Researchers at the University of Alberta (U of A) have released new updated guidelines and recommendations for improving patient safety and the handling of potassium products in hospital settings. However, the authors also reported there is a lack of strong evidence in support of specific best practice initiatives.
The researchers, led by Dr. Terry Klassen, undertook a review of literature (more than 2,500 citations) evaluating best practices for handling products containing potassium in hospital settings. Study results were published in the British Medical Journal in July.
This study was part of an independent review contracted by the Health Quality Council of Alberta following the deaths of two dialysis patients in February 2004 after receiving dialysate solution-containing formulations.
"We are stressing the urgent need to do more research in this area," explained Dr. Klassen, professor and chairman of the U of A department of pediatrics and director of the Alberta Research Centre for Child Health Evidence.
The next step should be national, systems-based research, he proposed, adding that systems need to take up and implement these strategies, then look at the impact of implementing them. "It's really important to examine that."
The single most often suggested strategy for reducing medication errors involving potassium chloride is to remove all stocks of concentrated potassium chloride from clinical areas.
However, according to a 1997 survey of U.S. hospitals, many hospitals continue to stock this medication in clinical areas.
Drug storage:
Remove concentrated potassium chloride from clinical areas.
Store potassium products in locked cupboards in clinical areas.
Eliminate the transfer of potassium products between wards and other clinical areas.
Drug preparation:
Have pre-prepared intravenous infusion available that contains potassium.
Prepare needed infusions in the pharmacy.
Drug packaging:
Ensure ampoules of potassium chloride are distinguishable from other injectable preparations.
Prescribing:
Prescribe potassium chloride in concentrations available as ready-made infusions.
Avoid "incomplete" and illegible prescribing.
Prescribe oral potassium chloride to treat hypokalemia when clinically feasible.
Drug administration:
Develop clear therapeutic guidelines defining the maximum concentration of potassium in an intravenous solution.
Develop clear therapeutic guidelines defining infusion rates for the administration of intravenous potassium.
Institute a double-check policy.
Ensure safe use of infusion pumps.
Pharmaceutical industry standards:
Encourage distinct, standardized labelling and packaging as an industry standard.
Source: Dr. Terry Klassen
By Barbara Kermode-Scott
CALGARY | Researchers at the University of Alberta (U of A) have released new updated guidelines and recommendations for improving patient safety and the handling of potassium products in hospital settings. However, the authors also reported there is a lack of strong evidence in support of specific best practice initiatives.
The researchers, led by Dr. Terry Klassen, undertook a review of literature (more than 2,500 citations) evaluating best practices for handling products containing potassium in hospital settings. Study results were published in the British Medical Journal in July.
This study was part of an independent review contracted by the Health Quality Council of Alberta following the deaths of two dialysis patients in February 2004 after receiving dialysate solution-containing formulations.
"We are stressing the urgent need to do more research in this area," explained Dr. Klassen, professor and chairman of the U of A department of pediatrics and director of the Alberta Research Centre for Child Health Evidence.
The next step should be national, systems-based research, he proposed, adding that systems need to take up and implement these strategies, then look at the impact of implementing them. "It's really important to examine that."
The single most often suggested strategy for reducing medication errors involving potassium chloride is to remove all stocks of concentrated potassium chloride from clinical areas.
However, according to a 1997 survey of U.S. hospitals, many hospitals continue to stock this medication in clinical areas.
Drug storage:
Remove concentrated potassium chloride from clinical areas.
Store potassium products in locked cupboards in clinical areas.
Eliminate the transfer of potassium products between wards and other clinical areas.
Drug preparation:
Have pre-prepared intravenous infusion available that contains potassium.
Prepare needed infusions in the pharmacy.
Drug packaging:
Ensure ampoules of potassium chloride are distinguishable from other injectable preparations.
Prescribing:
Prescribe potassium chloride in concentrations available as ready-made infusions.
Avoid "incomplete" and illegible prescribing.
Prescribe oral potassium chloride to treat hypokalemia when clinically feasible.
Drug administration:
Develop clear therapeutic guidelines defining the maximum concentration of potassium in an intravenous solution.
Develop clear therapeutic guidelines defining infusion rates for the administration of intravenous potassium.
Institute a double-check policy.
Ensure safe use of infusion pumps.
Pharmaceutical industry standards:
Encourage distinct, standardized labelling and packaging as an industry standard.
Source: Dr. Terry Klassen
