Background and importance Potassium chloride (KCl) for injection is identified as a high risk medicine and a ‘never events’. The development of quality assurance strategies for the KCl use process is essential to minimise risk.
Aim and objectives To assess compliance with guidelines for KCl prescription, pharmaceutical evaluation and administration for KCl use to identify priorities for improvement.
Material and methods A prospective observational study was conducted including patients treated with intravenous KCl (outside the intensive care unit) over 4 non-consecutive days from February to March 2020. The KCl use guidelines of the French National Agency for Medicines and Products Safety was considered as a reference. Data collected were: for the prescribing stage: indication, information that must appear on the prescription, concentration and flow rate; for the pharmaceutical evaluation stage: entry of pharmaceutical intervention (PI) for a non-compliant prescription; and for the administration stage: labelling, administered concentration and flow rate. Data were collected from the electronic medical records and the observation of KCl administration.
Results During the study period, 34 patients (53% men) were included, with a median age of 76 years (range 26–94). The KCl use process was compliant for 6% (2/34). The prescribing stage was non-compliant (NC) for 88% (30/34): 76% (26/34) with NC indication, 53% (18/34) with incomplete prescription and 12% (4/34) too concentrated. The pharmaceutical evaluation stage was NC for 83% (25/30): it was missing in 58% (15/26) of non-indication PI, 89% (16/18) of missed information PI and 75% (3/4) of NC concentration PI. The administration stage was NC for 68% (23/34): 53% (18/34) with incomplete labelling and 15% (5/34) too concentrated. The flow rate was 100% compliant.
Conclusion and relevance This study highlights a lack of compliance with recommendations. Because of this audit, we have identified an action plan for improvement: raising awareness of KCl good practices among physicians, pharmacists and nurses; identification of high risk medicines by a specific logo on software; and setting up intravenous KCl prescription protocols and an automatic reassessment request after 2 days. For pharmacists, it will be necessary to set up a simulation for pharmaceutical evaluation on fictional cases. For nurses, the labelling rules should be recalled.
Conflict of interest No conflict of interest
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