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Standing Order for Administration of potassium modifier (13g/50mL) into dialysis solution Medication Standing Order for Routine Procedures Document registration number: Site(s) where Standing Order applies All Haemodialysis units within HNELHD Administration of potassium modifier (13 g/50 mL) into dialysis solution Drug: Potassium modifier Target audience Nursing staff competent in dialysis treatment working in dialysis units across HNELHD To be used in conjunction with renal guidelines and procedures. Only for patients receiving dialysis treatment in HNELHD Nephrology, Haemodialysis, Dialysis, Potassium, Dialysate N/A Description Keywords Replaces Existing Standing Order? Document number and/ or name of superseded document/s Related Legislation (including OHS legislation), Australian Standards, NSW Health Policy or Circular, other HNEH Documents, Professional Guidelines, Codes of Practice or Ethics: - NSW Health Policy Directive PD2013_043 Medication Handling in NSW Public Health Facilities Person responsible for compilation Contact Details Authorisation: Signed (Nursing) Ginger Chu Renal Clinical Nurse Consultant (02) 49048815 <signature of responsible NUM or Service Manager in Unit> Date Signed (Medical) <signature of responsible MO in Unit> Date DTC or QUMC Approval <signature of Chairman of HNE Quality Use of Medicines Committee Date Revised Review N/A <due date of next review (usually annually)> Trim Number Details: This Standing order is to be used in the absence of an authorised prescriber during routine dialysis procedures. The HNELHD Quality Use of Medicines Committee has determined that the authorised prescriber is not required to confirm the administration by Version No. Month/Year Page 1 Standing Order for Administration of potassium modifier (13g/50mL) into dialysis solution countersigning the record of the administration. Presentation Potassium Modifier (13 g/50 mL) Indications for use To balance serum potassium during haemodialysis treatment Contraindications Normal serum potassium level for haemodialysis population Proposed Place in Therapy To be used in conjunction with dialysis solution and administered as requested prior to each dialysis treatment. Dosage The addition of 50 mL of potassium modifier will increase the potassium level by 1 mmol/L after dilution in 5 litres of part A haemodialysis solution. Pre-dialysis Serum potassium < 3 mmol/L 3-4 mmol/L >4 - 6 mmol/L >6 mmol/L or patients on digoxin Administration Monitoring requirements Dialysate Concentration K4 (2x50 mL potassium modifier in K2 part A solution) K3 (1x 50 mL potassium modifier in K2 part A solution) K2 Part A solution K2 part A solution + consultation with a medical officer Potassium modifier must be added to a full bottle of dialysis part A solution and mixed well. It is for single patient use, and must be discarded at the end of dialysis treatment. Dialysis part A solution and potassium modifier must be prescribed on the dialysis prescription Dialysis part A solution and potassium modifier must be checked by two nurses and counter signed on the label according to labelling policy. For acutely unwell patients or patients with recent diarrhoea or bowel surgery, potassium level needs to be monitored pre dialysis. For new patients, potassium level needs to be monitored at each dialysis session for 4-6 weeks until stabilise. For chronic patients, potassium level needs to be monitored monthly and prescription must be adjusted accordingly. Management of complications Over use of potassium additive may cause hyperkalaemia and lead to cardiac arrhythmia. For severe hyperkalaemia patients, extra dialysis sessions will need to be arranged to remove excess potassium. Adverse Drug Reaction N/A Interactions N/A Documentation This is a Standing Order for Routine Procedures and Programs as per HNE2013_043 Section 7.4. It has been determined by the HNELHD QUMC that the record of administration does not require countersigning by the authorized prescriber. Nursing staff administering the potassium modifier must record the dose, route and administration time on the medication label. This should be independently double checked by another nurse. A periodic review of documentation should be undertaken by the Renal leadership group annually or when matter raised under this document. Version No. Month/Year Page 2 Standing Order for Administration of potassium modifier (13g/50mL) into dialysis solution Version No. Month/Year Page 3