P34 The intravenous use of strong potassium chloride in paediatric intensive care (PICU)
Authors: Sharma Avinash , Isaac Rhian 
Published: April 2023

Aim

Incorrect use of strong potassium is listed as a ‘Never Event’,1a largely preventable patient safety incident if national2or healthcare provider guidance is followed. Local guidance for the use of strong intravenous (IV) potassium is available for paediatric intensive care, with multiple considerations to follow before it should be considered. This audit investigates the use of strong IV potassium in a Paediatric Intensive Care Unit (PICU) against the current PICU specific safety guidance. The aims being to assure and provide direction to improve compliance and patient safety.

Method

Audit standards were adapted from hospital guidelines on the use of IV strong potassium in PICU. Data points were set using these audit standards, and a standardised data collection form was piloted before being finalised. Data were collected during a 12 hour window each day over a total of 20 days. Patients were identified through entries in the potassium section of the PICU IV infusion chart. Data were analysed using excel.

Results

Nineteen out of 31 patients (61%) had their serum potassium measured within 2 hours of administration. Nineteen patients requiring IV strong potassium had increased urine output, with 11 of these (58%) having diuretic therapy review. Nine out of 28 patients (32%) had been prescribed a potassium sparing diuretic (PSD), with 3 patients excluded due to a recent serum potassium > 4.5 mmol/L. Of the patients not given a PSD, reasons included unintentional omission, being previously crossed off the chart and not re-prescribed, and a high urine output. Patients on IV maintenance fluids or parenteral nutrition could have their contents optimised. Optimisation of the potassium content in IV maintenance fluids or parenteral nutrition was missed with only 3 out of 13 patients (23%) on IV maintenance and 2 out of 9 patients on PN having the potassium content increased. Fifteen patients from the total of 31 (48%) were tolerating enteral feeds and should have been given oral potassium supplements where possible, as there was no clinical need or urgency to opt for IV.

Conclusion

Several steps detailed in PICU IV potassium guidance could reduce the need for IV strong potassium if followed to a greater extent, reducing the risks of using strong IV potassium. Relaunching the guideline and further education is required; with particular emphasis on the use of PSDs, optimising the potassium content of IV maintenance and parenteral nutrition, reviewing diuretic therapy, and oral potassium supplementation. Reminding prescribers that use of enteral potassium in patients tolerating enteral feeds should be considered prior to electing for the IV route. Education regarding the omission of PSD in patients with high urine output is required. Time savings could be made by following the guideline as IV strong potassium requires several safety checks and is time consuming to prepare. Following the relaunch of the guideline a re-audit is needed to measure whether the interventions have improved compliance and reduced the unnecessary risks of strong IV potassium use.3

References

NHS Improvement. Never Events list 2018 (updated February 2021). London, 2021. Available from: https://www.england.nhs.uk/publication/never-events/

National Patient Safety Alert. ‘Potassium solutions: risks to patients from errors occurring during intravenous administration.’ NPSA 2002.

Rhodes LA, Wall KM, Abernathy SL,et al. Decreasing IV potassium in pediatric cardiac intensive care: quality improvement project.Pediatr Crit Care Med2016;17:772–8.