Hypokalaemia in hospitalised patients.
OBJECTIVE
Hypokalaemia in inpatients is common, and is associated with morbidity and mortality. Its management is risky and not always effective. We launched an educational programme with the aim of increasing the rate of potassium normalisation during hospital stay, and of reducing unmonitored cases.


METHODS
The project consisted of three phases: (I) retrospective analysis on 26 471 patients hospitalised in 2012 in five acute care hospitals of southern Switzerland (Ente Ospedaliero Cantonale, EOC) with identification of improvement goals on a sample survey (588 cases of hypokalaemia); (II) revision of internal guidelines, and implementation of educational activities in one of the five hospitals (Ospedale Regionale di Locarno, ODL); (III) follow-up analysis on the 26 726 patients hospitalised in 2014 and second sampling to complete the evaluation of the efficacy of the intervention.


RESULTS
Phase I, ODL vs EOC: prevalence of hypokalaemia, 21.7 vs 23.2% (p <0.05); treated 53.1 vs 56.5% (not significant); normalisation 62.4 vs 61.1% (ns); absence of monitoring 18.3 vs 21.1% (p <0.05); time to normalisation 3.0 ± 2.7 vs 2.8 ± 2.4 days (ns); secondary hyperkalaemia 1.1 vs 1.4% (ns). Length of stay hypokalaemic vs normokalaemic 11.2 ± 11.7 vs 6.6 ± 7.9 days (p <0.001); falls 3.5 vs 1.7% (p <0.001), deaths 5.1 vs 3.1% (p <0.001). The severity/performance ratio suggested inefficiency. Phase III, ODL 2012 vs ODL 2014: treated 53.1 vs 75.7% (p <0.001); normalisation 62.4 vs 69.7% (p <0.01); absence of monitoring 20.1 vs 8.7 (p <0.01); time to normalisation 3.1 ± 2.7 vs 2.4 ± 2.6 days (ns); secondary hyperkalaemia 1.1 vs 1.8% (ns).


CONCLUSIONS
The management of hypokalaemia is characterised by dysfunctions; it can, however, be ameliorated by the implementation of internal guidelines and targeted educational activities. The length of hospital stay is increased in patients with hypokalaemia, shifting the expected length of hospital stay based on the Swiss Diagnosis Related Group classification.
Quality and Patient Safety Service, Ospedale Regionale di Locarno, Switzerland.
Angela
A
Greco
Quality and Patient Safety Service, Ospedale Regionale di Locarno, Switzerland.
Giovanni
G
Rabito
Clinical Pharmacy Service, Ente Ospedaliero Cantonale, Switzerland.
Michela
M
Pironi
Clinical Pharmacy Service, Ente Ospedaliero Cantonale, Switzerland.
Marco
M
Bissig
Clinical Pharmacy Service, Ente Ospedaliero Cantonale, Switzerland.
Saida
S
Parlato
Clinical Pharmacy Service, Ente Ospedaliero Cantonale, Switzerland.
Laura
L
Andreocchi
Division of Internal Medicine and Nephrology, Ospedale Regionale di Locarno, Switzerland.
Giorgia
G
Bianchi
Division of Internal Medicine and Nephrology, Ospedale Regionale di Locarno, Switzerland.
Marilù
M
Poretti Guigli
Division of Internal Medicine and Nephrology, Ospedale Regionale di Locarno, Switzerland.
Michael
M
Llamas
Division of Internal Medicine and Nephrology, Ospedale Regionale di Locarno, Switzerland.
Rita
R
Monotti
Division of General Surgery, Ospedale Regionale di Locarno, Switzerland.
Leander
L
Sciolli
Division of Internal Medicine and Nephrology, Ospedale Regionale di Locarno, Switzerland.
Franco
F
Ravetta
Department of Laboratory Medicine, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland.
Roberto
R
Della Bruna
Quality and Patient Safety Service, Ospedale Regionale di Locarno, Switzerland.
Anna
A
Zasa
Clinical Nutrition Service, Ospedale Regionale di Locarno, Switzerland.
Daniela
D
Stehrenberger
Division of Internal Medicine and Nephrology, Ospedale Regionale di Mendrisio, Switzerland.
Olivier
O
Giannini
Division of Internal Medicine and Nephrology, Ospedale Regionale di Bellinzona e Valli, Switzerland.
Luca
L
Gabutti
D019983:Guideline Adherence; D006282:Health Personnel / Q000193:education*; D006760:Hospitalization; D006801:Humans; D007008:Hypokalemia / Q000453:epidemiology*; D007902:Length of Stay; D011188:Potassium / Q000008:administration & dosage / Q000032:analysis / Q000097:blood; D012189:Retrospective Studies; D013557:Switzerland / Q000453:epidemiology
D011188:Potassium