Managing intravenous potassium infusion: a quality improvement study on clinician's beliefs and practice.

Jacqueline Colgan, Rebecca Balmer, Louise Allan, Claire McCormack, Kourouche Sarah
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Abstract

Background: Hypokalemia is a frequently occurring electrolyte disorder in hospital patients and is often treated with intravenous (IV) potassium replacement. In Australia, most hospital departments use IV potassium replacement therapies, which are known anecdotally to cause pain. To our knowledge, there have been no studies on Australian clinicians' practices in managing IV potassium replacement.

Aims: To investigate the management of IV potassium infusions by clinical staff in a regional Local Health District in New South Wales, Australia.

Methods: An interprofessional team of clinicians was formed and utilised the Plan-Do-Study-Act (PDSA) cycle. An online case-based survey was created to collect infusion management issues from clinicians' perspectives. The survey utilised a fictional case study with multiple-choice questions. It aimed to investigate clinicians' self-reported clinical practice behaviours when managing potassium infusions, which were analysed descriptively. Data from open-ended questions about managing potassium infusion pain were analysed using inductive content analysis.

Results: The study found that clinicians (n = 177) manage IV replacement, with two-thirds reporting multiple weekly instances. Clinicians observed that patients report pain during infusions. Factors such as potassium concentration (n = 130), patient anxiety (n = 118), peripheral administration (n = 109) and cannula sites in the lower arm (n = 102) were reported as pain risk factors. Clinicians reported using various strategies to manage infusion pain, including slowing the infusion, simple pain relievers, and topical applications. Severe potassium deficiency was a barrier to managing pain. Clinicians felt the management of pain to be challenging both clinically and ethically. Survey comments also suggest that IV potassium may be overused, presenting an opportunity for future improvement.

Conclusion: The PDSA cycle structured the quality improvement initiative. This research explores how clinicians manage IV potassium infusions. Our findings uncover how frequently clinicians manage pain caused by IV potassium infusions, an area that is not well-documented. Further research is needed for pain management strategies.

静脉输钾管理:临床医生信念与实践的质量改进研究。
背景:低钾血症是医院患者中常见的电解质紊乱,通常通过静脉(IV)钾替代治疗。在澳大利亚,大多数医院部门使用静脉钾替代疗法,据说这种疗法会引起疼痛。据我们所知,目前还没有关于澳大利亚临床医生管理静脉钾替代的研究。目的:了解澳大利亚新南威尔士州某地方卫生区临床工作人员静脉输注钾的管理情况。方法:组建了一个由临床医生组成的跨专业团队,并采用计划-执行-研究-行动(PDSA)循环。创建了一项基于病例的在线调查,从临床医生的角度收集输液管理问题。该调查采用了一个带有多项选择题的虚构案例研究。它旨在调查临床医生在管理钾输注时自我报告的临床实践行为,并对其进行描述性分析。采用归纳内容分析法对钾输注疼痛管理开放性问题的数据进行分析。结果:研究发现临床医生(n = 177)管理静脉置换术,三分之二报告每周多次。临床医生观察到患者在输液过程中报告疼痛。钾浓度(n = 130)、患者焦虑(n = 118)、外周给药(n = 109)和下臂插管位置(n = 102)等因素被报道为疼痛危险因素。临床医生报告使用各种策略来管理输液疼痛,包括减缓输液,简单的止痛药和局部应用。严重缺钾是控制疼痛的障碍。临床医生认为疼痛的管理在临床和伦理上都是具有挑战性的。调查意见还表明静脉注射钾可能被过度使用,这为未来的改善提供了机会。结论:PDSA循环构成了质量改进的主动性。本研究探讨临床医生如何管理静脉钾输注。我们的研究结果揭示了临床医生如何频繁地处理静脉钾输注引起的疼痛,这一领域没有得到很好的记录。疼痛管理策略需要进一步的研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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