POTASSIUM CHLORIDE CONCENTRATE SOLUTION FOR
INTRAVENOUS ADMINISTRATION
Version
5
Name of responsible (ratifying)
committee
Formulary and Medicines Group
Date ratified
16 January 2015
Document Manager (job title)
Director of Medicines Management and Pharmacy
Date issued
02 February 2015
Review date
01 February 2017
Electronic location
Clinical Policies
Related Procedural Documents
PHT Controlled Drugs Policy.
PHT Medicines Management Policy.
PHT Potassium Concentrate Solutions for IV
Administration: Safe Storage, Prescribing,
Administration and Dilution.
PHT Policy for the Safe Management of Injectable
Medicines (Adults and Children)
Key Words (to aid with searching)
Potassium, injectables, intravenous, medicine,
NPSA, Never Events, NHS England
Version Tracking
Version
Date Ratified
Brief Summary of Changes
Author
5
16/01/2015
New author. Review of products held at PHT. Inclusion
of disposal of potassium concentrate solutions
J C Simmons
Potassium Chloride Concentrate Solution for Intravenous Administration
Issue Number: 5
Date of Issue: 02 February 2015
Review date: 01 February 2017 (unless requirements change)
Page 1 of 8
QUICK REFERENCE GUIDE
This policy must be followed in full when developing or reviewing and amending Trust
procedural documents.
For quick reference the guide below is a summary of actions required. This does not negate
the need for the document author and others involved in the process to be aware of and
follow the detail of this policy.
This policy applies to all healthcare workers involved in the storage, prescribing,
administration and dilution of potassium concentrate solutions. This includes, but is not
exclusive to, doctors, pharmacists, pharmacy technicians / assistant technical officers,
nurses, midwives, operating department practitioners, healthcare support workers, and
delivery drivers.
The policy covers professional accountability of groups of workers and the following
processes regarding use of potassium containing concentrate solutions for intravenous use:
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Safe storage
Receipt
Prescribing
Dilution
Administration
Disposal
Potassium Chloride Concentrate Solution for Intravenous Administration
Issue Number: 5
Date of Issue: 02 February 2015
Review date: 01 February 2017 (unless requirements change)
Page 2 of 8
1. INTRODUCTION
This policy describes the storage and use of potassium chloride concentrate solution
intended for intravenous administration in clearly designated areas within PHT which
provides evidence for compliance with National Patient Safety Agency Patient Safety
Alert PSA01: Potassium Chloride Concentrate Solution.
2. PURPOSE
This policy has been developed to outline procedures to minimise and manage the risk
of inadvertent administration of potassium chloride concentrate solution by restricting
its availability as ampoules and vials, in accordance with the recommendations of the
NPSA. More recently this policy is instrumental in reducing the risk of ‘never events’
as originally determined by the DoH.
This policy aims to improve the awareness of PHT staff in the safe storage, ordering
and receipt, prescribing, administration and disposal of potassium chloride concentrate
solution intended for intravenous administration.
3. SCOPE
This policy applies to all staff working within Portsmouth Hospitals NHS Trust.
‘In the event of an infection outbreak, flu pandemic or major incident, the Trust
recognises that it may not be possible to adhere to all aspects of this document. In
such circumstances, staff should take advice from their manager and all possible
action must be taken to maintain ongoing patient and staff safety’
4. DEFINITIONS (see full list, Section 4 of the PHT Medicines Management
Policy)
Potassium Chloride Concentrate Solution – Potassium chloride 15% is the
injectable preparation in use at Queen Alexander Hospital, Portsmouth, in the following
critical care areas:
Potassium chloride
concentrate
solution
Concentration
Form
Critical Care Areas
Potassium Chloride
15% (1.5g/10ml)
2 mmol/ml
20 x 10ml ampoules
Critical Care Unit (E5)
Paediatrics (A7 Starfish &
A8 Shipwreck)
Children’s Assessment
Unit A Level
Renal (G7)
Renal High Care (G6)
Potassium Chloride Concentrate Solution for Intravenous Administration
Issue Number: 5
Date of Issue: 02 February 2015
Review date: 01 February 2017 (unless requirements change)
Page 3 of 8
Newborn Unit (B9)
Emergency Dept C Level
Cardiology (C7)
Respiratory (E8)
5. DUTIES AND RESPONSIBILITIES
Refer to the PHT Medicines Management Policy and the PHT Policy for the Safe
Management of Injectable Medicines (Adults and Children) for an explanation of the
duties and responsibilities.
6. PROCESS
6.1 Restrictions to stock holding
Stock of potassium chloride concentrate solution will be restricted to the pharmacy
department and the designated critical care areas as listed in section 4 of this document
to reduce the availability and risk of inadvertent use.
6.2 Storage
Stock of potassium chloride concentrate solution will be kept in their original outer
container and stored in the controlled drug cupboards of the designated critical care
areas ( PHT Controlled Drugs Policy.). This is to ensure that the solution is separated
from the common diluting solutions such as water for injections and sodium chloride
0.9% for injection.
6.3 Ordering
Potassium chloride concentrate solution will only be supplied from the pharmacy
department to the designated critical care areas if the order has been made using a CD
order book (PHT Controlled Drugs Policy.). Transfers between clinical areas are
prohibited.
6.4 Documentation of ordering and administering
Documentation of ordering, supply and receipt of potassium chloride concentrate
solution will use the same system as controlled drugs (PHT Controlled Drugs Policy.).
Records of all administration to patients will be documented in a designated controlled
drugs record book. A robust audit trail comprising ordering, storage, receipt, destruction
and administration of potassium chloride concentrate solution will be maintained to
provide accountability.
6.5 Prescribing
Prescriptions for potassium solutions for intravenous use will be restricted to
commercially available dilute solutions so eliminating the need for solutions to be made
and potential errors. Deviation from this would only occur in the case of an unequivocal
need for a special solution to be compounded.
6.6 Approved range of products
Potassium Chloride Concentrate Solution for Intravenous Administration
Issue Number: 5
Date of Issue: 02 February 2015
Review date: 01 February 2017 (unless requirements change)
Page 4 of 8
Commercially prepared intravenous infusions containing potassium are available to all ward
areas to reduce the need for these areas to keep concentrated solutions. See Drug Therapy
Guideline No: 2.05 PHT Potassium Concentrate Solutions for IV Administration :Safe
Storage, Prescribing, Administration and Dilution.
6.7 Second check
When dilution of potassium chloride concentrate solution is required in a designated critical
area a second practitioner should always check against the prescription for correct selection
of product, dosage, dilution, mixing, labelling and administration route and rate. See Drug
Therapy Guideline No: 2.05 PHT Potassium Concentrate Solutions for IV Administration
:Safe Storage, Prescribing, Administration and Dilution.
6.8 Administration rate
All infusions containing potassium at concentrations greater than 40mmol/l must be
administered via a high-risk infusion pump to control the rate of infusion.
 Usual maximum infusion rate in adults is 10mmol per hour.
 Faster rates may be used, however, ECG monitoring is required if the rate of
infusion is greater than 20mmol per hour
 In severe hypokalaemia the infusion rate should not exceed 40mmol per hour.
(In exceptional circumstances in the Department of Critical Care only and only
when sanctioned by the consultant in charge, the rate may exceed 40
mmol/hour.)
 In paediatric and neonatal patients the maximum infusion rate should be
0.2mmol/kg/hour. (In exceptional circumstances, only when sanctioned by the
consultant in charge, the rate used may be up to 0.5mmol/kg/hour.)
The maximum concentration of potassium that can be given via a peripheral line is
40mmol/l, concentrations greater than this should be given via a central line.
6.9 Disposal
The procedure for handling expired or unwanted stock of concentrated solutions is the
same as for other controlled drugs: (PHT Controlled Drugs Policy)
Stock identified as being past the expiry date or no longer wanted must be clearly
identified as not for use and retained in the locked controlled drugs cupboard used for
storage of concentrated potassium solutions. The stock must not be signed out of the
controlled drugs register at this stage.
The ward/directorate pharmacist should be contacted and they will arrange for
removal.
Unwanted or expired ready-diluted commercially available solutions can be returned to
pharmacy or disposed of in the POM bins.
6.10 Out of hours
The on-call pharmacist must be contacted to arrange a supply of potassium containing
concentrate solutions. The out of hours definition can be found on the pharmacy
webpage.
6.11 Ante-natal clinic
During late termination of pregnancy potassium chloride 15% (2mmol/ml) is required
for use according to Royal College of Obstetricians and Gynaecologists to ensure
foetal asystole prior to birth. In these cases a prescription will be written by the
Potassium Chloride Concentrate Solution for Intravenous Administration
Issue Number: 5
Date of Issue: 02 February 2015
Review date: 01 February 2017 (unless requirements change)
Page 5 of 8
consultant for 1 x 10ml ampoule of potassium chloride 15% which will be dispensed by
the pharmacy department and delivered to the prescriber for immediate use.
If required out of hours the On Call Pharmacist must be contacted for supply to permit
the issue of potassium chloride concentrate solution in these circumstances.
If for any reason the potassium chloride it is not used, the ampoule must be returned to
pharmacy as soon as is practical to ensure the unused ampoule is accounted for.
6.12 Patient Safety Incidents / Never Events
Never events are a sub-set of Serious Incidents and are defined as ‘serious, largely
preventable patient safety incidents that should not occur if the available preventative
measures have been implemented by healthcare providers
The never event with regard to potassium chloride concentrate solution refers to death
or severe harm as a result of maladministration of a potassium-containing solution.
In this definition maladministration refers to:
 Selection of strong potassium solution instead of intended other medication
 Wrong route administration, for example a solution intended for central venous
catheter administration given peripherally
 Infusion at a rate greater than intended
Any medication-related incident fulfilling this criteria and any adverse incident involving
potassium chloride concentrate solution should be reported using Datixweb as a
serious incident requiring investigation (SIRI) following the Policy for the Management
of Serious Incidents Requiring Investigation (SIRI) Policy.
7. TRAINING REQUIREMENTS
The contents of this policy and risks associated with potassium chloride concentrate
solutions will be included in induction training for pharmacy, nursing and clinical staff.
Refer to the PHT Medicines Management Policy for details regarding training and
competencies.
8. REFERENCES AND ASSOCIATED DOCUMENTATION
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Patient safety alert – Potassium chloride concentrate solutions, 2002 (updated 2003),
available at http://www.nrls.npsa.nhs.uk/resources/?entryid45=59882
Standard Operating Protocol fact sheet; Managing Concentrated Injectable Medicines,
part of the WHO High 5’s project, available at
https://www.high5s.org/bin/view/Main/WebHome
The never events list; 2013/14 update, NHS England available at
http://www.england.nhs.uk/wp-content/uploads/2013/12/nev-ev-list-1314-clar.pdf
(accessed 8/1/15)
Injectable Drug Administration Guide, UCL Hospitals, 3rd Edition. 2011
Neonatal Formulary 6. The Northern Neonatal Network. British Medical Journal Books
2011
BNFc December 2014 available at
https://www.medicinescomplete.com/mc/bnfc/current/PHP14008-intravenouspotassium.htm (accessed 9/1/15)
Potassium Chloride Concentrate Solution for Intravenous Administration
Issue Number: 5
Date of Issue: 02 February 2015
Review date: 01 February 2017 (unless requirements change)
Page 6 of 8
9. EQUALITY IMPACT STATEMENT
Portsmouth Hospitals NHS Trust is committed to ensuring that, as far as is reasonably
practicable, the way we provide services to the public and the way we treat our staff
reflects their individual needs and does not discriminate against individuals or groups
on any grounds.
This policy has been assessed accordingly
All policies must include this standard equality impact statement. However, when
sending for ratification and publication, this must be accompanied by the full equality
screening assessment tool. The assessment tool can be found on the Trust Intranet ->
Policies -> Policy Documentation
Our values are the core of what Portsmouth Hospitals NHS Trust is and what we
cherish. They are beliefs that manifest in the behaviours our employees display in the
workplace.
Our Values were developed after listening to our staff. They bring the Trust closer to
its vision to be the best hospital, providing the best care by the best people and ensure
that our patients are at the centre of all we do.
We are committed to promoting a culture founded on these values which form the
‘heart’ of our Trust:
Respect and dignity
Quality of care
Working together
No waste
This policy should be read and implemented with the Trust Values in mind at all times.
Potassium Chloride Concentrate Solution for Intravenous Administration
Issue Number: 5
Date of Issue: 02 February 2015
Review date: 01 February 2017 (unless requirements change)
Page 7 of 8
10. MONITORING COMPLIANCE WITH PROCEDURAL DOCUMENTS
This document will be monitored to ensure it is effective and to assurance compliance.
Minimum
requirement to be
monitored
Annual Medicines
Management Audit
Lead
Risk Management
Pharmacy
Technician
Tool
JAC pharmacy
stock control
system
Frequency of
Report of
Compliance
Annually
Reporting arrangements
Policy audit report to:

Medication safety committee
Policy audit report to:

Policy audit report to:

Potassium Chloride Concentrate Solution for Intravenous Administration
Issue Number: 5
Date of Issue: 02 February 2015
Review date: 01 February 2017 (unless requirements change)
Page 8 of 8
Lead(s) for acting on
Recommendations
CSC Governance Leads