Background/Significance: There are 5700 children in the United States with End Stage Renal Disease. The management of hyperkalemia & hyperphosphatemia in children with end-stage renal disease pose clinical challenges. There are limited treatments or preventive alternatives for pediatric patients at risk of hyperkalemia & hyperphosphatemia.  Infants and children with renal disease often have increased serum potassium or phosphorus values. Decanting is accomplished by adding Kayexalate or Sevelamer to formula or breastmilk, to decrease the potassium or phosphorus content. The process of decanting lowers the morbidity and mortality for these patients. BCH has led the way to develop a safe process for decanting formula.
An interdisciplinary team identified an opportunity to evaluate resources available at point of care after several safety events occurred on the unit.  It was decided that this was a hospital-wide safety concern.
Purpose and Goals: The purpose of this quality improvement project was to evaluate the current practice of decanting formula or breastmilk with Kayexalate and Sevelamer and to standardize the practice across the enterprise.
Methods: To identify best practices, a comprehensive review of the literature was conducted. Meetings with an interdisciplinary committee (Nurse scientist, professional development specialist, pharmacist, renal dieticians, nurse manager, and nurse) occurred frequently. Updated information about decanting with Kayexalate and Sevelamer was reviewed by the Pharmacy Committees. Dissemination occurred at the Surgical Services Research, Clinical Inquiry and Quality Outcomes committee and staff meetings. Labels were developed and standardized to identified a formula or breast milk that was in the process of decanting and to identify the formula or breast milk that was ready to feed.  References about decanting are now housed in the formulary and e-library, so that staff have more options to access. Clinical guidelines and family education sheets were updated to have the same language.
Findings: There have not been any safety events since standardizing decanting. Staff have commented that they are more comfortable with the process.
Implications/Next Steps: Dissemination of information will continue. New decanting labels to be added to hospital central supply.