Pharmacotherapy management in patients with potassium disorders

Introduction: Potassium (K) is the principal intracellular cation, essential for maintaining the function of various organs. It is a critical component of cardiac conduction and has a narrow therapeutic/toxic range. The objective of this study is to analyze the effect of pharmaceutical intervention through Computerized Prescription Order Entry (CPOE) in hospitalized patients with K disorders. Method: A prospective study carried out over six weeks. In-patients with blood K level alterations were included. Previously, pharmacists introduced drug information involved in K disorders as a support in the prescription program. We selected patients using a link with laboratory data (= 3 y = 5.4 mmol/l). Daily, the pharmacists reviewed pharmacotherapy in order to detect possible medication errors related to K+ disorders. We analyzed the result of pharmaceutical recommendations and physician acceptance rate. Results: 183 patients were included (average age was 17 ±67 years), 128 patients (69.9%) with hypokalemia and 55 (30.1%) with hyperkalemia. A total of 3,380 medical orders were prescribed, of which 540 (16%) could affect K levels mainly due to furosemide, piperacillin-tazobactam and meropenem. Pharmacists thoroughly studied 687 orders in terms of preventing possible medication errors. 232 (33.8%) required pharmaceutical recommendation, 196 of them (84.5%) were related to optimizing K therapy in hypokalemia status and 36 (15.5%) were safety recommendations for closer monitoring. Clinicians accepted 69.8% of recommendations. Conclusions: There is a high rate of prescription errors related to K disorders that could lead to patient safety events. Pharmaceutical intervention through CPOE helps to minimize them and increases physician awareness of the necessity of closer K monitoring in these patients