Acute Kidney Injury explained on the background of a QIP

QIP outcome and AKI

1. AKI and AKI Care Bundle (QIP) Dr Hafiz Sohail Kamran  SpR MECU DGFT Russls  Hall Hospital , West Midlands ,Dudley 

2. Why AKI Care Bundle  AKI is one of the common finding in hospitalised patients 7-18 % hospitalised patients and 57 % in ICU  AKI has impact on both Mortality and in patients Hospital stay   Adherence to  AKI Care Bundle will improve the management of such patients very efficient as these easy steps can be easily missed/ignored.  A paper published in BMC Nephro revealed that adherence to AKI care bundle reduced moderate and severe AKI 

3. QIP  Retrospectively collected data 2 cycle of audits done  The data from first audit revealed  that physicians were not very much familiarised  to the AKI care bundle  After Actions data showed improved in all aspects of AKI care bundle 

4. Results  1st Cycle  Conclusions - We collected the data for 30 patients being admitted at AMU -Only 5 patients had AKI bundle filled with only 7 patients about 23% has their urine analysis done on their first presentation . -The audit is suggestive that Bloods have been done everyday for most of patients with AKI about 29/30. -Nephrotoxic drugs have been reviewed by doctors in 97% of patients but pharmacy have reviewed only 50% of patients . -Renal imaging has been requested for only 60% of patients about 18 in total on first presentation -Specialist review for AKI 2-3 have been requested for only 6 (20%) of the patients in our case .

5. Actions after first  cycle :  1-Teaching of All junior doctors at local AMU teaching sessions . 2-AKI bundle should be part of Induction panel for all junior doctors. 3-Pharmacy emphasis on reviewing nephrotoxic drugs for all patients being admitted with AKI . 4- AKI bundle to be displayed at all AMU stations .

6. Second cycle  In the second cycle of the audit , we found out that doctors are still ignoring to follow AKI care bundle . The good outcome is that this document for AKI care bundle has now been changed to electronic document on sunrise . Teaching sessions have been arranged for the new doctors who joins the trust and in AMU , the team is making sure that AKI care bundle has been sent to all doctors on their induction. There is very slight improvement , may be due to data was collected earlier plus in this part of time there have been induction of large number of new doctors who have never worked in NHS before , but now due to all activities , doctors are more aware to fill this document . We will try to involve our Nurses as well as to Invite Pharmacist to the next teaching session on AKI care bundle . We have contacted a renal Consultant as well for discussion , on to bring the services of AKI Nurse and AKI Service like the way we have in Resp and Diabetes . All above measure will improve the outcome in future , We will repeat the third cycle after going through above recommendations.

7. Comparison  1st Cycle 1 - Was AKI bundle filled and placed in documents 17 % yes , 83 % No  ----------------------------------------------------------------------- 2 - Is urine analysis being done 23 % Yes , 77 % No  ----------------------------------------------------------------------- 3 - Daily bloods done especially creatinine 93 % yes , 7 % No  ------------------------------------------------------------------------ 4 - Review for nephrotoxic agents or drugs dependent on renal clearance 97% yes , 3 % No  ------------------------------------------------------------------------- 5 - Pharmacy review for drugs and dosage 50% Yes , 50 % No  -------------------------------------------------------------------------- 6 - Renal imaging requested 60% Yes , 40 % No   -------------------------------------------------------------------------- 7 - Specialist Renal review for AKI –III   20% yes , 80 % No  Second cycle 1 -Was AKI bundle filled and placed in documents  70 %  Yes , 30 % No  ------------------------------------------------------------------------- 2 -Is urine analysis being done 70 % yes , 30 % No  ------------------------------------------------------------------------- 3 -Daily bloods done especially creatinine 97 % Yes , 3 % No  ------------------------------------------------------------------------- 4 -Review for nephrotoxic agents or drugs dependent on renal clearance 93 %  yes , 7 % No  ----------------------------------------------------------------------- 5 -Pharmacy review for drugs and dosage 83 % , 17 % No -------------------------------------------------------------------------- 6 -Renal imaging requested 77 % Yes , 23 % No  ----------------------------------------------------------------------- 7 -Specialist Renal review for AKI –III  30 %  yes , 70 % No