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

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.