Standardizing the Early Identification of Acute Kidney Injury: The NHS England National Patient Safety Alert

Nephron ◽  
2015 ◽  
Vol 131 (2) ◽  
pp. 113-117 ◽  
Author(s):  
Nicholas M. Selby ◽  
Robert Hill ◽  
Richard J. Fluck ◽  
Keyword(s):  
Acute Kidney Injury ◽  
Patient Safety ◽  
Early Identification ◽  
Kidney Injury ◽  
Safety Alert ◽  
National Patient

scholarly journals P13 Optimising paediatric intravenous fluid management plans: a quality improvement project

2020 ◽  
Vol 105 (9) ◽  
pp. e12.2-e13
Author(s):  
Jenny Gray ◽  
Susie Gage
Keyword(s):  
Patient Safety ◽  
Nursing Staff ◽  
Fluid Balance ◽  
Medical Staff ◽  
Fluid Management ◽  
Management Plan ◽  
Intravenous Fluid ◽  
Safety Alert ◽  
Management Plans ◽  
National Patient

IntroductionIntravenous (IV) maintenance fluids are often prescribed post-surgery when enteral routes are contraindicated. Serious consequences have been documented when poor fluid management has occurred, as highlighted in the National Patient Safety Alert (NPSA) 22; reducing the risk of hyponatraemia; when administering IV fluids to children.1 In response to this, the National Institute for Health and Care Excellence (NICE) published their guidance in December 2015 regarding IV fluids in children.2 Based on NICE recommendations, a pan hospital fluid guidance was produced. Within the NICE and hospital’s own guideline it states that there should be a daily fluid management plan documented. It has been well recognised that this daily fluid management plan was not routinely been completed; hence showing non-adherence to our hospital policy and NICE recommendations.AimsPrimary aim was to improve the documentation of the daily fluid management plan; aimed at the medical staff and the secondary aim was to improve the monitoring requirements of IV fluids and documentation of these; largely aimed at the nursing staff.MethodsA simple sticker was designed and attached to continuous sheets for medical notes which had a checklist of monitoring requirements and a section for fluid balance. Additionally, 2 posters were produced; one aimed at medical staff for documenting a fluid management plan and one aimed at the nursing staff with the monitoring requirements. These posters were displayed on the paediatric surgical ward.ResultsA total of 22 patients who were prescribed IV fluids were identified for a baseline measurement, an equal number of patients were compared after the intervention. Neonates and children receiving total parenteral nutrition were excluded from the data collection. There were 41% of daily fluid management plans completed pre intervention and post intervention there were 56% completed; showing a 15% increase in completion. As regards the monitoring indications; there were increases for nursing fluid balance completed from 19% to 46%, blood glucose taken and recorded from 64% to 83% and the daily weight documented from 10% to 49%.ConclusionsThis short QI project shows that implementation of an intervention did improve outcomes across all indications investigated. The results are not as dramatic as first hoped, but this is largely due to the short time scale of 4 weeks to introduce our change and it coincided with the change-over month of junior medical staff. With further education and champions within the medical and nursing teams; further improvement is very much possible, with the main aim in reducing risk and improving patient safety.ReferencesNational Patient Safety Alert: Reducing the risk of hyponatraemia when administering intravenous infusions to neonates 2007. Available at https://www.sps.nhs.uk/articles/npsa-alert-reducing-the-risk-of-hyponatraemia-when-administering-intraveneous-infusions-to-neonates/ [Accessed 12th June 2019]NICE guidance: Intravenous fluid therapy in children and young people in hospital. Available at https://www.nice.org.uk/guidance/ng29 [Accessed 12th June 2019]

scholarly journals Implementation of clinical decision support to manage acute kidney injury in secondary care: an ethnographic study

2019 ◽  
Vol 29 (5) ◽  
pp. 382-389
Author(s):  
Simon Bailey ◽  
Carianne Hunt ◽  
Adam Brisley ◽  
Susan Howard ◽  
Lynne Sykes ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Patient Safety ◽  
Quality Improvement ◽  
Decision Support ◽  
Clinical Decision Support ◽  
Kidney Injury ◽  
Clinical Decision ◽  
Ethnographic Study ◽  
Routine Practice ◽  
Trade Offs

BackgroundOver the past decade, acute kidney injury (AKI) has become a global priority for improving patient safety and health outcomes. In the UK, a confidential inquiry into AKI led to the publication of clinical guidance and a range of policy initiatives. National patient safety directives have focused on the mandatory establishment of clinical decision support systems (CDSSs) within all acute National Health Service (NHS) trusts to improve the detection, alerting and response to AKI. We studied the organisational work of implementing AKI CDSSs within routine hospital care.MethodsAn ethnographic study comprising non-participant observation and interviews was conducted in two NHS hospitals, delivering AKI quality improvement programmes, located in one region of England. Three researchers conducted a total of 49 interviews and 150 hours of observation over an 18-month period. Analysis was conducted collaboratively and iteratively around emergent themes, relating to the organisational work of technology adoption.ResultsThe two hospitals developed and implemented AKI CDSSs using very different approaches. Nevertheless, both resulted in adaptive work and trade-offs relating to the technology, the users, the organisation and the wider system of care. A common tension was associated with attempts to maximise benefit while minimise additional burden. In both hospitals, resource pressures exacerbated the tensions of translating AKI recommendations into routine practice.ConclusionsOur analysis highlights a conflicted relationship between external context (policy and resources), and organisational structure and culture (eg, digital capability, attitudes to quality improvement). Greater consideration is required to the long-term effectiveness of the approaches taken, particularly in light of the ongoing need for adaptation to incorporate new practices into routine work.

scholarly journals Clinical profile and outcome of acute kidney injury in intensive care unit of a teaching hospital

2018 ◽  
Vol 8 (1) ◽  
pp. 32-35
Author(s):  
Bidhan Shrestha ◽  
Sabita Shrestha ◽  
Rakshya Shrestha ◽  
Pramod Paudel ◽  
Hari Krishna Dhakal ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Early Identification ◽  
Laboratory Tests ◽  
Kidney Injury ◽  
Clinical Profile ◽  
Medical College ◽  
Acute Kidney Disease ◽  
Renal Function Tests

Objectives: Acute kidney injury is one of the most common cause of hospitalization in developing countries. Causes of AKI are multifactorial. Most of AKI are community acquired. The objective of the study was to identify the clinical profile and outcome of acute kidney disease. Subject and Methodology: 30 patients from Chitwan Medical College outpatient clinic were included in the study from November 2014 to April 2015. A brief history and clinical examinations were taken from all patients along with laboratory tests for Renal function tests, urine output, metabolic parameters and hematological profile. Results: 19 males (63.3% and 11 females (36.7%) were studied. The main causes for AKI were sepsis (46.6%) followed by hepatic causes (16.6%), gastroenteritis (10%) and others (10.2%). Out of 30 patients, 19 recovered (63.3%) and were discharged and 11(36.7%) died. Most of the deaths were in injury (37.5%) and failure (42.8%) stages of RIFLE criteria. Out of 19 recovered 16(84.21%) patients did not need any renal replacement therapy whereas 3(15.8%) patients had to undergo hemodialysis. Conclusion: Early identification of kidney injury may lead to lesser renal replacement therapy and better prognosis. However late presentations of AKI have higher hospital mortality rate.

Acute kidney injury

2020 ◽  
pp. 135-156
Author(s):  
Cristina Osorio ◽  
Theofanis Fotis
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Function ◽  
Nursing Care ◽  
Early Identification ◽  
Kidney Injury ◽  
Anatomy And Physiology ◽  
Renal Replacement Therapies ◽  
Life Threatening ◽  
Kidney Anatomy

Assessing and supporting kidney function is an integral aspect of acute care. AKI (acute kidney injury) may cause sudden, life-threatening biochemical disturbances and hence the early identification, escalation to treatment and management of AKI is an important focus in the management of acutely ill patients. This chapter reviews kidney anatomy and physiology followed by the nursing care involved in assessing and managing abnormal kidney function. The focus is on relevance and applicability to clinical practice and understanding of kidney function as protective measures and early detection of anomalies greatly reduces the risk of acute kidney injury. Common renal pathologies are explored and the role of renal replacement therapies is discussed.

scholarly journals Nurses' knowledge to identify early acute kidney injury

2016 ◽  
Vol 50 (3) ◽  
pp. 399-404 ◽  
Author(s):  
Roseli Aparecida Matheus do Nascimento ◽  
Murillo Santucci Cesar Assunção ◽  
João Manoel Silva Junior ◽  
Cristina Prata Amendola ◽  
Taysa Martindo de Carvalho ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Intensive Care ◽  
Early Identification ◽  
Clinical Manifestations ◽  
Kidney Injury ◽  
Prevention Measures ◽  
Treatment Results ◽  
Know How ◽  
Multi Center Study ◽  
Center Study

Abstract OBJECTIVE To evaluate the knowledgeof nurses on early identification of acute kidney injury (AKI) in intensive care, emergency and hospitalization units. METHOD A prospective multi-center study was conducted with 216 nurses, using a questionnaire with 10 questions related to AKI prevention, diagnosis, and treatment. RESULTS 57.2% of nurses were unable to identify AKI clinical manifestations, 54.6% did not have knowledge of AKI incidence in patients admitted to the ICU, 87.0% of the nurses did not know how to answer as regards the AKI mortality rate in patients admitted to the ICU, 67.1% answered incorrectly that slight increases in serum creatinine do not have an impact on mortality, 66.8% answered incorrectly to the question on AKI prevention measures, 60.4% answered correctly that loop diuretics for preventing AKI is not recommended, 77.6% answered correctly that AKI does not characterize the need for hemodialysis, and 92.5% said they had no knowledge of the Acute Kidney Injury Networkclassification. CONCLUSION Nurses do not have enough knowledge to identify early AKI, demonstrating the importance of qualification programs in this field of knowledge.

Assessment of the implementation of a national patient safety alert to reduce wrong site surgery

2008 ◽  
Vol 17 (6) ◽  
pp. 409-415 ◽  
Author(s):  
P Rhodes ◽  
S J Giles ◽  
G A Cook ◽  
A Grange ◽  
R Hayton ◽  
...  
Keyword(s):  
Patient Safety ◽  
Wrong Site Surgery ◽  
Safety Alert ◽  
National Patient ◽  
Wrong Site

scholarly journals AKI Risk Score (AKI-RiSc): Developing an Interpretable Clinical Score for Early Identification of Acute Kidney Injury at the Emergency Department

2021 ◽  
Author(s):  
Yukai Ang ◽  
Siqi Li ◽  
Marcus Eng Hock Ong ◽  
Feng Xie ◽  
Su Hooi Teo ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Acute Kidney Injury ◽  
Risk Score ◽  
Early Identification ◽  
Kidney Injury ◽  
Clinical Score ◽  
Risk Scores ◽  
Singapore General Hospital ◽  
Hospitalised Patients

Abstract Acute kidney injury (AKI) in hospitalised patients is a common syndrome associated with poorer patient outcomes. Clinical risk scores can be used for the early identification of patients at risk of AKI. We conducted a retrospective study using electronic health records of Singapore General Hospital emergency department patients who were admitted from 2008 to 2016. The primary outcome was inpatient AKI of any stage within 7 days of admission based on Kidney Disease Improving Global Outcome (KDIGO) 2012 guidelines. A machine learning AutoScore algorithm was used to generate clinical scores from the study sample which was divided into training, validation and testing cohorts. Model performance was evaluated using area under the curve (AUC). Among the 119,468 admissions, 10,693 (9.0%) developed AKI. 8,491 were stage 1 (79.4%), 906 stage 2 (8.5%) and 1,296 stage 3 (12.1%). The AKI Risk Score (AKI-RiSc) was a summation of the integer scores of 6 variables: serum creatinine, serum bicarbonate, pulse, systolic blood pressure, and diastolic blood pressure. AUC of AKI-RiSc was 0.730 (95% CI: 0.713 – 0.747), outperforming an existing AKI Prediction Score model which achieved AUC of 0.665 (95% CI: 0.646 – 0.679) on the testing cohort. At a cut-off of 4 points, AKI-RiSc had a sensitivity of 82.5% and specificity of 46.7%. AKI-RiSc is a simple clinical score that can be easily implemented on the ground for early identification of AKI and potentially be applied in international settings.

scholarly journals (TIMP2) x (IGFBP7) as early renal biomarker for the prediction of acute kidney injury in aortic surgery (TIGER). A single center observational study

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0244658
Author(s):  
Jan Waskowski ◽  
Carmen A. Pfortmueller ◽  
Noelle Schenk ◽  
Roman Buehlmann ◽  
Juerg Schmidli ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Observational Study ◽  
Early Identification ◽  
Kidney Injury ◽  
Single Center ◽  
Early Assessment ◽  
Aortic Repair ◽  
Abdominal Aortic ◽  
Sensitivity Specificity ◽  
Single Center Observational Study

Objective Postoperative acute kidney injury (po-AKI) is frequently observed after major vascular surgery and impacts on mortality rates. Early identification of po-AKI patients using the novel urinary biomarkers insulin-like growth factor-binding-protein 7 (IGFBP7) and tissue inhibitor of metalloproteinases-2 (TIMP-2) might help in early identification of individuals at risk of AKI and enable timely introduction of preventative or therapeutic interventions with the aim of reducing the incidence of po-AKI. We investigated whether biomarker-based monitoring would allow for early detection of po-AKI in patients undergoing abdominal aortic interventions. Methods In an investigator-initiated prospective single-center observational study in a tertiary care academic center, adult patients with emergency/ elective abdominal aortic repair were included. Patients were tested for concentrations of urinary (TIMP-2) x (IGFBP7) at baseline, after surgical interventions (PO), and in the mornings of the first postoperative day (POD1). The primary endpoint was a difference in urinary (TIMP-2) x (IGFBP7) levels at POD1 in patients with/ without po-AKI (all KDIGO stages, po-AKI until seven days after surgery). Secondary endpoints included sensitivity/ specificity analyses of previously proposed cut-off levels and clinical outcome measures (e.g. need for renal replacement therapy). Results 93 patients (n = 71 open surgery) were included. Po-AKI was observed in 33% (31/93) of patients. Urinary (TIMP-2) x (IGFBP7) levels at POD1 did not differ between patients with/ without AKI (median 0.39, interquartile range [IQR] 0.13–1.05 and median 0.23, IQR 0.14–0.53, p = .11, respectively) and PO (median 0.2, IQR 0.08–0.42, 0.18, IQR 0.09–0.46; p = .79). Higher median (TIMP-2) x (IGFBP7) levels were noted in KDIGO stage 3 pAKI patients at POD1 (3.75, IQR 1.97–6.92; p = .003). Previously proposed cutoff levels (0.3, 2) showed moderate sensitivity/ specificity (0.58/0.58 and 0.16/0.98, respectively). Conclusion In a prospective monocentric observational study in patients after abdominal aortic repair, early assessment of urinary (TIMP-2) x (IGFBP7) did not appear to have adequate sensitivity/ specificity to identify patients that later developed postoperative AKI. Clinicaltrials.gov NCT03469765, registered March 19, 2018.

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