By Amanda Gin and Natalie Benninger
Highly concentrated electrolytes are manufactured with the intention of being diluted prior to administration. These include all calcium salts with concentrations great than 10%, magnesium sulfate concentrations greater than 20%, potassium salts with concentrations greater than or equal to 2 mmol/mL, and sodium chloride concentrations greater than 0.9%. Concentrated electrolyte solutions are considered high-alert medications, with an increased risk for significant harm if administered in error. Ensuring safe and coordinated use of high-alert medications is a Required Organizational Practice. Accreditation Canada stipulates that the availability of concentrated electrolytes is evaluated and limited to ensure that formats with the potential to cause patient harm are not stocked in client service areas without appropriate safeguards. Click here for the Q-Tip.
Women’s College Hospital (WCH) promotes safety best practices when dispensing, storing and administering high-alert medications including concentrated electrolytes. WCH limits the procurement and stocking of concentrated electrolytes within the Pharmacy Department. These include calcium gluconate 100mg/mL, calcium chloride 100mg/mL and magnesium sulfate 500mg/mL.
Only under limited and specific care circumstances is it necessary to store concentrated electrolytes in patient care areas. Select concentrated electrolytes are stored in sealed and locked emergency defibrillator carts in the Acute Ambulatory Care Unit (AACU), Operating Rooms (OR) and the Post-Anesthesia Unit (PAU) for use in sudden and life-threatening emergencies. Select concentrated electrolytes (magnesium sulfate and calcium gluconate) are also stocked in limited numbers in the AACU locked narcotic cabinet for the rare but occasional need to administer electrolytes to patients after hours in the AACU. Additional safeguards include:
- Storage of limited numbers of concentrated electrolytes in the locked narcotic cabinet in the AACU medication room that requires authorized employee badge entry.
- Each vial is labelled with a high-alert “Concentrated Electrolyte” sticker which alerts clinicians that further dilution is required.
- No concentrated electrolytes are stored in any other patient care areas at WCH.
- Daily audits by pharmacy technicians to ensure safe and appropriate usage of concentrated electrolytes after hours.
- Regular audits by the pharmacy department to ensure appropriate storage and distribution of concentrated electrolytes.
During Pharmacy hours, and in non-emergency situations, concentrated electrolytes are only administered pursuant to a patient-specific medication order complete with medication name, route and dose. These orders are verified by a pharmacist and dispensed with appropriate double-checks in place. Clinicians consult the IV Drug Monographs available on the WCH Intranet for instructions on diluting concentrated electrolytes, maximum concentrations, rates of infusion, and monitoring (i.e., cardiac monitoring, vitals, etc.) prior to administering the electrolyte.
You can learn more by reviewing the following policy documents
To learn more about Accreditation, visit the Accreditation Intranet Hub.