Evaluation of the adherence to a new potassium chloride storage and handling hospital protocol: an observational study.

The study aim to deal with problem of manage potassium chloride concentrate solution after the introduction of a new protocol on correct use (storage and handling) of these drugs in a high specialization-teaching hospital. The study, conducted from January 2009 to March 2009, was divided in two part: observation of the compliance of concentrated electrolytes solutions storage in 14 wards and prospective observational study on the compliance to the new protocol in the steps of prescription, preparation and administration of these drugs. 49 preparations and administrations of electrolytes solutions were observed. Medical prescriptions were made in a dedicated schedule in 40.8% (20/49), in therapy sheet in 36.7% (18/49), in 14.3% (7/49) the prescription was verbal and after written. Patient identified data was present in 85.7% of cases, solvent type in 61.2%, prescription date in 69.4%, prescription hour in 10.2%, signature of prescriptor in 77.6%, administration speed in 57.1%, administration date in 71.4%, administration hour in 32.7%. Data show a scarce knowledge of the protocol by the physicians or a difficulty in using an additional schedule respect to the existent. Lack of the prescriptor's signature was an important problem such as the absence of speed, date and hour of administration.

Evaluation of the implementation of the alert issued by the UK National Patient Safety Agency on the storage and handling of potassium chloride concentrate solution.

OBJECTIVES: To assess the effectiveness of the response of NHS hospital trusts to an alert issued by the National Patient Safety Agency designed to limit the availability of concentrated potassium chloride in hospitals in England and Wales, and to determine the nature of any unintended consequences. DESIGN: Multi-method study involving interviews and a physical inspection of clinical areas. SETTING: 207 clinical areas in 20 randomly selected acute NHS trusts in England and Wales between 31 October 2002 and 31 January 2003. PARTICIPANTS: Senior managers and ward based medical and nursing staff. MAIN OUTCOME MEASURES: Degree of staff awareness of and compliance with the requirements of the national alert, withdrawal of concentrated potassium chloride solutions from non-critical areas, provision of pre-diluted alternatives, storage and recording in accordance with controlled drug legislation. RESULTS: All trusts required that potassium chloride concentrate be stored in a separate locked cup-board from common injectable diluents (100% compliance). Unauthorized stocks of potassium chloride were found in five clinical areas not authorized by the trust (98% compliance). All trusts required documentation control of potassium chloride concentrate in clinical areas, but errors were recorded in 20 of the 207 clinical areas visited (90% compliance). Of those interviewed, 78% of nurses and 30% of junior doctors were aware of the alert. CONCLUSIONS: The NPSA alert was effective and resulted in rapid development and implementation of local policies to reduce the availability of concentrated potassium chloride solutions. The success is likely to be partly due to the nature of the proposed changes and it cannot be assumed that future alerts will be equally effective. Continued vigilance will be necessary to help sustain the changes.