633 Improving the Quality of AKI Management Within a District General Surgery Department

Abstract

Abstract Introduction Acute kidney injuries (AKI) affect 1/5 patients requiring acute hospital admission. The NCEPOD report (2009) described only 50% of AKI care as “good”. Swift identification and appropriate management of AKI is vital. We aimed to assess and improve our adherence to NICE guidance(QS76, NG48) on managing AKI. Method Retrospective review of paper notes was conducted in patients admitted under general surgery at Royal Alexandra Hospital found to have a > 50% increase in the serum creatinine. We assessed the completion of a urinalysis and withholding of nephrotoxic medications within 24 hours of AKI identification, and duration of AKI. First cycle was conducted in August 2020. An AKI alert card was introduced outlining the identification of an AKI and initial management. This provided an effective method of recording interventions in patient notes and accessible education on current guidelines to foundation doctors. The second cycle commenced mid-December and is ongoing. Results First cycle included 30 patients; median age was 77(IQR:67-85). Adherence to urinalysis and nephrotoxic guidance was completed in 9/30(30%) and 13/30(43%) respectively. Median duration of AKI was 7(IQR:5-12) days. Second cycle has identified 17 patients so far; median age is 75(IQR:68-91). Adherence to urine dip and nephrotoxic guidance improved to 11/17(65%)(p < 0.05) and 16/17(94%)(p < 0.05) respectively. Median duration of AKI also improved to 3(IQR:2-7) days (p < 0.05). Conclusions Our interim results show a positive effect to the management of AKI following the introduction of our AKI Alert Cards. Reduction in overall duration of AKI highlights patient benefit.