title: Recognition and management of acute kidney injury in hospitalised patients can be partially improved with the use of a care bundle.
abstract: Acute kidney injury (AKI) is common in hospitalised patients but is known be suboptimally managed; the National Confidential Enquiry into Patient Outcomes and Death (NCEPOD) report in 2009 identified significant failings in AKI care. An audit, using standards suggested by the NCEPOD report, of all adult inpatients with AKI in a large central-London NHS hospital in a 7-day period in 2011 showed poor recognition and management of AKI. In response, an AKI 'care bundle' was developed and deployed throughout the hospital along with a programme of enhanced education. Re-audit in 2013 showed that AKI was significantly more likely to have been recognised by the clinical team than in 2011, and patients with AKI were significantly more likely to have had fluid status clinically assessed and nephrotoxic medication stopped in 2013 than in 2011. There was no significant improvement in fluid administration if assessed as hypovolaemic and compliance with the guideline for prevention of contrast nephropathy. In 2011, all audit measures were met in 3.7% of patient-days versus 8.4% in 2013. More in-depth work is necessary to better understand the factors which limit optimal care.
authors.affiliation: Guy's and St Thomas' NHS Foundation Hospital, London, UK.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Joslin
authors.affiliation: Guy's and St Thomas' NHS Foundation Hospital, London, UK.
authors.forename: Hannah
authors.initials: H
authors.lastname: Wilson
authors.affiliation: Guy's and St Thomas' NHS Foundation Hospital, London, UK.
authors.forename: Daniel
authors.initials: D
authors.lastname: Zubli
authors.affiliation: Guy's and St Thomas' NHS Foundation Hospital, London, UK.
authors.forename: Nathan
authors.initials: N
authors.lastname: Gauge
authors.affiliation: General and Geriatric Medicine, Guy's and St Thomas' NHS Foundation Hospital, London, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Kinirons
authors.affiliation: General and Geriatric Medicine, Guy's and St Thomas' NHS Foundation Hospital, London, UK.
authors.forename: Adrian
authors.initials: A
authors.lastname: Hopper
authors.affiliation: Guy's and St Thomas' NHS Foundation Hospital, London, UK.
authors.forename: Taryn
authors.initials: T
authors.lastname: Pile
authors.affiliation: Critical Care and Nephrology, Guy's and St Thomas' NHS Foundation Hospital, London, UK marlies.ostermann@gstt.nhs.uk.
authors.forename: Marlies
authors.initials: M
authors.lastname: Ostermann
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000628:therapy*; D000368:Aged; D054869:Clinical Audit; D005260:Female; D006801:Humans; D008297:Male; D064872:Patient Care Bundles
keywords: Acute kidney injury; audit; care bundle