October 2007, Volume 3, Issue 10 - Control of Concentrated Electrolyte Solutions

Dear Colleagues, 

Continuing our series of theme issues on the WHO Collaborating Centre for Patient Safety’s set of nine Patient Safety Solutions (read more here), this month’s Patient Safety Link focuses on Solution Five, “Control of Concentrated Electrolye Solutions” (read the entire solution here). Frequently, reversing the effects of improperly administered concentrated electrolytes is impossible, and death is a typical patient outcome. As stated in the Solution, “It is especially critical that the availability, access, prescribing, ordering, preparation, distribution, labeling, verification, administration, and monitoring of [concentrated electrolyte solutions] be planned in such a way that possible adverse events can be avoided, and, hopefully, be eliminated.”

With that goal in mind, our first article, “High-Alert Meds,” details common risk factors of high-alert medications and proactive planning tips to ensure patients are safe from medication errors. Our book excerpt, “Principles and Practices of Medication Storage” from Joint Commission Resources’ and the American Society of Health-System Physicians’ The Handbook on Storing and Securing Medications, presents direction on proper administration of floor stock medication, including actions and rationales for safe storage. Finally, we provide links to more articles on the subject of monitoring the use of concentrated electrolytes via the Center’s Patient Safety Practices Web portal, and recommend that you use the site frequently for tips, tools, and resources for addressing other patient safety problems as well. 

Can your organization teach others via your positive experiences with Control of Concentrated Electrolyte Solutions?  Let us know about your success! Send an email by selecting this link: http://www.jcipatientsafety.org/24725/.