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Alert issued after cardiac arrests in hyperkalaemia patients

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Nurses and other clinicians have been told to treat all people with high potassium levels as an emergency, after 35 people including a baby and child suffered a cardiac arrest.

The alert issued today by NHS Improvement comes alongside new guidance on treating people with high levels of potassium in their blood – a condition known as hyperkalaemia.

“It is vital that patients with high potassium levels in their blood are treated as an emergency”

Kathy McLean

It follows a series of incidents in which people with the potentially life-threatening condition went on to suffer a cardiac arrest due to delays in getting treatment and lack of monitoring.

Reports to the National Reporting and Learning System reveal that there were 35 cases where people who were hyperkalaemic went on to suffer a cardiac arrest. The cases include one child and one baby who arrested while being treated in hospital.

Hyperkalaemia can be successfully tackled with intravenous medication but NHS Improvement said the reports revealed delays in providing treatment and inadequate ongoing monitoring by staff.

One incident report showed that a patient who had received treatment was not checked again over a 17-hour period. Treatment for hyperkalaemia was given at about 4.30pm.

“However, no further review of the patient was undertaken and no repeat treatment or bloods were done until the patient arrested at 09.26,” said the report.

Another incident revealed a lack of understanding of the seriousness of the condition. “The patient had a raised potassium which required treatment and [a member of staff] apparently stated that the day team could deal with it,” said the report.

“High blood potassium levels are extremely dangerous and can lead to cardiac arrest”

Kathy McLean

NHS Improvement told Nursing Times that the 35 patients in question had survived the particular incidents of cardiac arrest documented in the reports.

However, a spokeswoman added that the patients were being treated for a range of serious conditions and may have suffered further arrests or gone on to die from other causes.

The guidance for NHS staff highlights the fact the human body’s response to high potassium levels can be unpredictable with an irregular heart beat or full cardiac arrest occurring without warning – even if a patient looks well.

It stresses hyperkalaemia can affect patients in hospital and those being cared for at home. It can also affect those with a range of conditions with kidney disease and heart-related problems like high blood pressure among the most common causes

Crucially, there may be no visible signs of hyperkalaemia other than blood test results.

Dr Kathy McLean, NHS Improvement executive medical director and chief operating officer, said it was important staff were aware of the condition and that people with high potassium levels received urgent treatment.

NHS Improvement

Kathy McLean

Kathy McLean

“High blood potassium levels are extremely dangerous and can lead to cardiac arrest,” she said. “It is vital that patients with high potassium levels in their blood are treated as an emergency and given treatment quickly and monitored.

“The alert we have published today will help the NHS treat and monitor every patient who has this potentially life-threatening condition,” she added.

Alongside the guidance, NHS Improvement has produced two videos – one for hospitals and one for GP practices – to help staff monitor and treat hyperkalaemia.

The body has told trusts they need to ensure staff are aware hyperkalaemia is a potentially life-threatening emergency and have the right knowledge and training to treat and monitor it.

Trust will be expected to revise their own guidance and training in the light of the alert and ensure these are available to all staff including bank and agency nurses – with a deadline of nine months to ensure key changes are made.

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