A multidisciplinary approach to reducing spurious XXXX in hospital outpatient clinics.

@entity1 @entity8 @entity4144 @entity972
AIMS AND OBJECTIVES: To describe a multidisciplinary effort to investigate and reduce the occurence of outpatient spurious hyperkalaemia. BACKGROUND: @entity4144 is a falsely elevated serum @entity972 result that does not reflect the in  vivo condition of a @entity1 . A common practice of fist clenching/pumping during phlebotomy to improve vein visualisation is an under-appreciated cause of spurious @entity4144 . DESIGN: Pre- and postinterventional study. METHOD: Objective evidence of spurious hyperkalaemia was sought by reviewing archived laboratory results. A literature review was undertaken to summarise known causes of spurious hyperkalaemia and develop a best practice in phlebotomy. Subsequently, nurses from the Urology Clinic were interviewed, observed and surveyed to understand their phlebotomy workflow and identify potential areas of improvement by comparing to the best practice in phlebotomy. Unexplained (potentially spurious) hyperkalaemia was defined as a serum @entity972 of >5  0  mmol/l in a @entity1 without stage 5 chronic @entity8 or haemolysed blood sample. RESULTS AND CONCLUSION: Nurses from the Urology Clinic showed significant knowledge gap regarding causes of spurious hyperkalaemia when compared to the literature review. Direct observation revealed @entity1 were routinely asked to clench their fists, which may cause spurious hyperkalaemia. Following these observations, several educational initiatives were administered to address the knowledge gap and stop fist clenching. The rate of unexplained hyperkalaemia at the Urology clinic reduced from a baseline of 16  0-3  8%, 58  weeks after intervention. Similar education intervention was propagated to all 18 other specialist outpatient clinic locations, which saw their rate of unexplained hyperkalaemia decrease from 5  4 to 3  7%. To ensure sustainability of the improvements, the existing phlebotomy standard operating protocol, educational and competency testing materials at variance with the best practice were revised. RELEVANCE TO CLINICAL PRACTICE: A simple intervention of avoiding fist clenching/pumping during phlebotomy produced significant reduction in the rate of spurious @entity4144 .
