Development and proposed implementation of a standardised hypokalaemia management algorithm in the emergency department

Hypokalaemia is a common electrolyte disturbance encountered in emergency departments (EDs), potentially contributing to life-threatening arrhythmias and cardiac arrest if not promptly recognised and treated. Despite its frequency, many EDs lack a unified, practical protocol for its management, resulting in variability in treatment and reduced staff confidence.

This project aimed to design a clinical algorithm to support consistent and evidence-based management of hypokalaemia in the ED. The goal was to introduce this algorithm into clinical practice and, subsequently, to evaluate its impact through a quality improvement project (QIP).

A literature review was conducted to inform the development of a hypokalaemia algorithm/flow chart aligned with national and international guidelines. The draft algorithm was presented to ED consultants for approval. Concurrently, a survey of 22 ED staff members assessed the frequency of hypokalaemia presentations, confidence in managing severe hypokalaemia, and perceived need for a local protocol. Results indicated that 95.5% had not received formal training on hypokalaemia, and 95.5% agreed that an algorithm would be beneficial. Confidence in managing severe hypokalaemia without guidance was low, with 77.3% rating their confidence below 4/5.

The algorithm addresses the classification of hypokalaemia severity, intravenous and oral replacement strategies, monitoring requirements, and guidance for cardiac arrest scenarios. Consultant feedback on the algorithm was positive, highlighting its clarity and clinical utility. Plans are underway to roll out the algorithm in the department, with pre- and post-implementation audits to measure its impact on clinical outcomes and staff confidence.

The introduction of a structured hypokalaemia management algorithm in the ED fills a critical gap in care. This initiative promotes patient safety, supports clinician decision-making, and establishes a foundation for ongoing quality improvement.