Does The Joint Commission allow concentrated electrolytes to be stored outside of the pharmacy in patient care areas?

Under limited circumstances, it may be necessary to store concentrated electrolytes in specific patient care areas. Such decisions should be based on the results of a robust risk assessment followed by implementation of appropriate safeguards that address all identified risk points.  As a general rule, concentrated electrolytes are not be kept in patient care areas where access is not urgently needed.

Concentrated electrolytes may be described as solutions manufactured and distributed with the intention of being diluted prior to administration.  Examples include but not limited to:  Hypertonic Premix Saline Solution 3%; Sodium Chloride 23.4% solution; Potassium Chloride 2mEq/ml, Sodium Bicarbonate 8.4%, and Magnesium Sulfate 50%. When these solutions are available on a patient care unit, the risk is significant that accidental administration may occur without first diluting, especially during an emergency.  Examples of clinical areas where stocking concentrated electrolytes may be indicated include: crash carts located in intensive care units, the emergency department, procedural or interventional suites, emergency response medication boxes, cardioplegia solutions in the operating room for use during cardiac surgery, substance abuse detox programs, etc.

The foundation for conducting a proactive risk assessment would be based on the services provided and patient population served in each respective patient care area being considered for storage of such solutions. If it is determined that they are required, leadership would need to designate the appropriate locations for storage (i.e. emergency carts, automated medication dispensing cabinets, dialysis unit, etc.) as well as which concentrated electrolytes would be appropriate. The population served by each storage device or storage location should also be evaluated as such storage areas may serve a mixed patient population.

A proactive risk assessment examines a process in detail including sequencing of events, actual and potential risks, and failure or points of vulnerability and that prioritizes, through a logical process, areas for improvement based on the actual or potential impact (that is, criticality) of care, treatment, or services provided.

The introductory section of the Leadership (LD) chapter provides an example of a pro-active risk assessment model that an organization may use.  However, this specific approach is not mandated as there are other risk assessment tools available that may better meet the needs of the organization.   Other examples may include a root cause analysis, failure mode and effect analysis, plan/do/check/act process, etc., or combinations and variations.

When an organization determines that concentrated electrolytes will be stored outside of the pharmacy, appropriate safeguards must be developed to prevent inadvertent administration of these medications without proper dilution. Examples of strategies to prevent errors may include:

Individual State Pharmacy Boards
Institute for Safe Medication Practices