Promoting oral potassium administration in a tertiary care hospital: An eleven-year study - 10/01/19
Promouvoir de potassium par voie orale dans un hôpital universitaire: étude de onze années
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Highlights |
• | Potassium exhibits all the characteristics of the ideal medication to be included in an intravenous to per os therapy conversion program. |
• | Risks associated with the use of concentrated solutions of potassium chloride should stimulate hospital pharmacists to promote potassium replacement by oral route. |
• | Departments where the highest volumes of concentrated ampoules are administered, intensive care and visceral surgery, should be considered as priority targets. |
Summary |
Introduction |
Potassium is used to treat or prevent hypokalemia and exhibits all the characteristics of an intravenous to oral therapy conversion program. Despite this, the intravenous route for potassium replacement seems frequently unjustified.
Objectives |
To determine the impact of a conversion program on the use of intravenous and oral galenic forms in a university tertiary care hospital.
Methods |
Two promotion campaigns were conducted in 2006 and 2009. The following years this was completed by pharmacist interventions during prescription analysis and face-to-face discussions with physicians during ward rounds. The consumption of products containing potassium was obtained by analyzing the hospital's financial database.
Results |
The proportion of the oral route increased from 18% in 2006 to 22% in 2011, and from 25% in 2012 to 44% in 2016; the increase was significantly greater in the second period (P<0.0001). In 2016, in emergency, pulmonology, infectious diseases, and cardiology departments, the proportion of oral use ranged from 57% and 82%. The greatest progression from 2006 to 2016 was found for intensive care (4% vs. 12%) and visceral surgery departments (9% vs. 34%) that increased approximately four-fold, followed by the emergency department (28% vs. 57%) that increased approximately two-fold.
Conclusion |
Promoting the oral route for potassium replacement modifies prescriber habits and is followed by a notable increase in the proportion of potassium administered orally irrespective of department type.
Il testo completo di questo articolo è disponibile in PDF.Résumé |
Objectifs |
Le potassium utilisé pour traiter ou prévenir l’hypokaliémie présente toutes les caractéristiques d’inclusion dans un programme de promotion de la voie orale à chaque fois qu’elle est possible. Nous avons étudié l’impact de cette promotion sur l’utilisation des ampoules injectables et des formes orales apportant du potassium dans un centre hospitalo-universitaire.
Méthodes |
Deux campagnes de promotion basées sur des recommandations écrites ont été menées en 2006 et 2009. Les années suivantes, les pharmaciens ont promu la voie orale lors de l’analyse des prescriptions. La consommation des spécialités contenant du potassium a été obtenue en interrogeant la base de données financière de l’hôpital.
Résultats |
La proportion de la voie orale est passée de 18 % en 2006 à 22 % en 2011 et de 25 % en 2012 à 44 % en 2016. L’augmentation a été significativement plus importante dans la seconde période (p<0,0001). En 2016, dans les services d’urgences, de pneumologie, de maladies infectieuses et de cardiologie, la proportion des formes orales variait de 57 % à 82 %. Les soins intensifs (4 % vs 12 %) et la chirurgie viscérale (9 % vs 34 %) ont progressé d’environ un facteur quatre, suivi du service des urgences (28 % vs 57 %) qui a augmenté d’environ deux fois.
Conclusion |
La promotion de la voie orale pour la supplémentation en potassium modifie les habitudes de prescription. Cependant, la quantité d’ampoules concentrées circulant à l’hôpital restant importante, le risque d’erreur médicamenteuse lié à ces ampoules reste élevé.
Il testo completo di questo articolo è disponibile in PDF.Keywords : Potassium replacement, Concentrated potassium chloride, Oral solution, Oral route, Intravenous to oral switch
Mots clés : Supplémentation en potassium, Solution concentrée de chlorure de potassium, Solution orale, Voie orale, Relais de la voie injectable par la voie orale
Mappa
Vol 77 - N° 1
P. 38-45 - Gennaio 2019 Ritorno al numeroBenvenuto su EM|consulte, il riferimento dei professionisti della salute.
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