Saudi Cultural Missions Theses & Dissertations
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Item Restricted Evaluation of an Updated Hyperkalaemia Treatment Protocol and Electronic Orderset in Hospitalised Patients: Adherence, Safety Outcomes and Effectiveness.(Saudi Digital Library, 2025) Alrashdi, Ghada; Sawiere, Sarah; Levkovich, Bianca; Lau, WallisBackground: Hyperkalaemia is a life-threatening medical emergency, affecting up to 10% of hospital admissions. In 2023, UK guidance and an MHRA safety alert mandated standardised calcium dosing and structured monitoring, but adherence in practice is unknown. This study is the first large-scale UK inpatient evaluation of adherence, monitoring, safety outcomes and effectiveness following implementation of the updated protocol and electronic orderset. Methods: A retrospective cohort study included adult inpatients (≥18 years) with serum potassium ≥5.5 mmol/L between July-December 2024. Data from the electronic health record were analysed at prescription and episode levels. Results: A total of 379 prescriptions from 234 hyperkalaemia episodes were analysed. Adherence to the calcium gluconate dose (30 mL) was 93.4% overall, higher with orderset use (94.6% vs. 85.7%) but not statistically significant (p = 0.094). Adherence to the insulin-glucose regimen was 99.1%, with full compliance achieved using the orderset (100% vs. 94.4%, p = 0.004). Post-insulin blood glucose monitoring was poor: only 1.7% of prescriptions achieved the target of ≥9 readings within six hours, while 10.8% had none. Orderset use did not improve compliance (p = 0.621). Hypoglycaemia occurred in 17.2% of treated episodes and hyperglycaemia in 28.6%. Treatment effectiveness showed 65.8% achieved normokalaemia after a single prescription, with outcomes more influenced by baseline severity than prescribing method. Conclusions: The updated protocol achieved high dosing adherence, with the orderset supporting standardisation; however, calcium gluconate underdosing and poor glucose monitoring remain safety risks. Embedding predefined monitoring intervals and reinforcing adherence through education may help address these gaps.14 0