Skip to content

INJECTABLE POTASSIUM CHLORIDE: AUDIT OF PRESCRIPTION AND ADMINISTRATION PRACTICES

European Statement

Patient Safety and Quality Assurance

Author(s)

Yosr Trabelsi, Leila Achour, Ikram Fezaa, Samer Sahbi, Chema Drira

Why was it done?

Never events are serious incidents generally linked to human and/or practical errors, which should never happen. Most of these events are avoidable, and are the subject of specific recommendations for the implementation of appropriate protective measures. According to ANSM (French drug safety agency), potassium chloride (KCl) is among the drugs frequently implicated in Never Events.

What was done?

The aim of this study was to assess the prescription and administration practices of injectable KCL in our hospital.

How was it done?

We carried out a 1-month prospective audit between 1 and 30 September 2024. All the prescriptions of injectable KCL were collected and evaluated by a pharmacist using a data collection form. It was divided into 2 sections: preparation and administration. The reference guideline used for this study was the 2022 ANSM recommendations. The results were analyzed using excel.

What has been achieved?

Fifty-five prescriptions were included. The compliance percentage for prescriptions and administration practices was 31.4% and 30.5 %, respectively. Calculation of total intake was compliant and the total volume of diluent was mentioned in all the prescriptions. In 62% of the prescription, the correct specific units were used and in 38.2 % of cases the correct slow infusion rate was prescribed. Nevertheless, the use of the route was inappropriate since only the IV route was prescribed due to the shortage of oral KCl. For administration, final concentration (≤4g/L) of the KCL infusion was respected in 90.9% of cases and all the preparations were labeled.

What next?

The study revealed several non-conformities, leading to the development of an improvement report. Therefore, we decided to implement a training plan about injectable KCl use to ensure patient safety.

×

Deadline extended to July 15th

Problems caused by shortages are serious, threaten patient care and require urgent action.

Help us provide an overview of the scale of the problem, as well as insights into the impact on overall patient care.

Our aim is to investigate the causes of medicine and medical device shortages in the hospital setting,  while also gathering effective solutions and best practices implemented at local, regional, and national levels.

×

Join us in Prague for the 2nd edition of BOOST!

Secure your spot in the Movement for Shortage-Free World

BOOST is where visionaries, innovators, and healthcare leaders come together to tackle one of the biggest challenges in hospital pharmacy—medicine shortages.