The Impact of a Computerized Potassium Alert on Adverse Drug Events and Pharmacists' Interventions

Abstract

Hyperkalemia, if left untreated, can lead to sudden death from cardiac arrhythmias. Hyperkalemia is defined as a serum potassium concentration greater than 5.5 mEq/L. It may develop when potassium intake exceeds excretion or when the transcellular distribution of potassium is disturbed. 1,2 At our institution, hyperkalemia was the most common adverse drug event (ADE).The clinical presentation of hyperkalemia is related to the effects of high potassium levels on neuromuscular, cardiac, and smooth muscle cells. Symptoms include generalized fatigue, muscle weakness, twitching, paresthesias, nausea, cramping, paralysis, palpitations, and cardiac abnormalities. 1 Thrombocytosis, leukocytosis, hemolysis, sickle cell disease, renal insufficiency or failure, Addison's disease, hyporenin aldosteronism, pseudohypoaldosteronism, insulin resistance or deficiency, hypertonicity, rhabdomyolysis, burns, and trauma are common causes of hyperkalemia. 3 Medications can also cause hyperkalemia through different mechanisms. Drug-induced hyperkalemia can result from the use of angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), nonsteroidal antiinflammatory drugs (NSAIDS), aldosterone antagonists, potassium supplements, nonselective β-blockers, heparin (with prolonged use), tacrolimus, succinylcholine, penicillin G potassium, pentamidine, ketoconazole, cy-

The evidence for the effectiveness of safety alerts in electronic patient medication record systems at the point of pharmacy order entry: a systematic review

“…Four of the five studies were conducted in an integrated care facility (Health Maintenance Organisation (HMO)) [20,21,33,34] and one in a hospital [14]. Three studies were randomised controlled trials (RCTs) [20,33,34], while two were before-after intervention design studies [14,21]. The publication dates for the studies ranged from 2007–2011.…”

“…Four studies [20,21,33,34] compared baseline characteristics of patients but only one explicitly reported no significant differences in patients’ characteristics at baseline [33]. The five studies evaluated alerts to contraindicated prescribing in the following categories: drug-drug [21], drug-laboratory [14,33], drug-pregnancy [34] and drug-age [20]. …”

“…Drug-lab alert [14,33] is generated when administration of a drug requires close monitoring of certain physiological parameters both before and after administration. A drug-pregnancy alert [34] is generated when administration of a drug is contraindicated in pregnancy while a drug-age alert [20] relates to a warning to the user of the system that certain medications might be contraindicated based on the age of the patient.…”

“…The results of the two studies: a RCT [33] and a before-after study [14] featuring drug-laboratory alerts indicated that the intervention had a beneficial effect. The primary outcome in the RCT [33], was the proportion of medication errors defined as target drugs that should be avoided or were dosed inappropriately.…”

“…In the before-after study [14], the alert warned pharmacists about potassium level above the set value and was tracked 63 times over the 3-month alert implementation period with the largest number of cases occurring during order entry for a potassium supplement (20 cases) and an ACE inhibitor (34 cases). Prior to implementation of alert, 48 hospitalized patients were treated for hyperkalaemia but only 14 cases of hyperkalaemia required treatment after the alert was implemented, a statistically significant decrease in ADEs related to hyperkalaemia (p<0.001).…”