Hypokalaemia: Improving the investigation, management and therapeutic monitoring of hypokalaemic medical inpatients at a district general hospital

Abstract

Hypokalaemia is prevalent in 20% of hospitalised patients. Furthermore, inadequate management of hypokalemia was identified in 24% of these patients. Associated with significant patient morbidity and mortality, the identification, investigation, and treatment of hypokalaemia was identified as an area for improvement in the management of medical inpatients.The project aims to measure the assessment, management, and therapeutic monitoring of medical inpatients with hypokalaemia in a district general hospital.All medical inpatients over a one week period who met the criteria for hypokalaemia (serum potassium <3.5 mmol/L on standard biochemical sample) were included in the audit. Patient's notes were located and evaluated to identify if they had mild, moderate, or severe hypokalaemia. Further data on ECG requests, repeat U&Es, serum magnesium analysis, treatment prescribed, and medication review dates was collated. A re-audit was completed after the introduction of a set of interventions which included a hypokalaemia treatment algorithm.Pre-intervention analysis of all medical inpatients, who met our inclusion criteria for hypokalaemia, identified 32 patients. 25 of these patients met the criteria for mild hypokalaemia (3.1–3.4 mmol/L) and 7 met the criteria for moderate hypokalaemia (2.5–3.0 mmol/L). Only 7/32 (22 %) patients were receiving adequate treatment based on trust guidelines.Post intervention results showed marked improvement in the management of patients with hypokalaemia. A total of 30 patients were identified in this post-intervention group. There were 16/30 patients who qualified as mild hypokalaemia (3.1–3.4 mmol/L) and 14/30 with moderate hypokalaemia (2.5–3.0 mmol/L). 19/30 (63%) patients in the post-intervention group were correctly prescribed appropriate medication doses consistent with the treatment algorithm.Following the initial success of the project, analysis at 3 months showed a positive trend for sustained improvement when compared to the pre-intervention results.

Hypokalaemia: Addressing human factors and improving education around prescription and administration of Intravenous(IV) Potassium infusion in Trauma and Orthopaedics

“…One similar project is reported in the BMJ Quality Improvement Reports journal in which there was an uncertainty of appropriate investigation and management of hypokalaemia including lack of medication review, ECG assessments, and blood monitoring leading to hyperkalaemia 8. This was not an issue in our study however the interventions made and improvement outcomes were similar.…”

Prediction of in‐hospital hypokalemia using machine learning and first hospitalization day records in patients with traumatic brain injury

“…Previous investigations, including our published study, have shown that hypokalemia is associated with unfavorable outcomes including increased mortality and prolonged hospital stay for TBI patients 3,5 . Yet, clinical signs of hypokalemia are often confounded with injuries and underlying diseases during the acute phase of TBI, which may lead to delayed diagnosis and unfavorable consequences 6 . It is therefore hypothesized that identifying patients with high risks of hypokalemia at the earliest stage may provide chances of prophylactic treatment and improve outcomes for TBI patients.…”

A retrospective analysis of postoperative hypokalemia in pituitary adenomas after transsphenoidal surgery

“…Total-body potassium is predominantly present as an intracellular component. In clinical medicine, hypokalemia is one of the most frequently electrolyte abnormalities, affects multiple organ systems, and contributes to a significant risk of morbidity and mortality ( Crop et al, 2007 ; Jordan & Caesar, 2015 ).…”