A XAVIER1, T JACOBSON1,R GILMORE1, Y LIM1
1Goulburn Valley Health, Shepparton, Australia
Background: Acute Kidney Injury (AKI) is present in 5-20%¹ hospitalized patients. Delay in recognition is one of the main hurdles to appropriate management of AKI. We audited the care of patients that had AKI prior to setting up an AKI e-alert system.
Method: An algorithm² on the hospital reporting system was set up to capture patients who had AKI based on creatinine rise. Those with AKI during February 2018 were audited. We looked at promptness in diagnosis and the early management of AKI. This included addressing their medications, targeting blood pressure of >110 systolic, an input /output chart, urine dipstick and renal imaging if appropriate.
Results: 46 (10% of all acute adult admissions) patients had AKI and were included in this audit. Majority of the patients 36 (78%) had AKI 1, 1(2%) patient had AKI 2 and 9 (20%) had AKI 3. 36 (78%) were over 60 yrs of age. Majority (98%) of the patients with AKI 2 and 3 had early recognition (within 24 hrs) and appropriate care.10 (32%) of those with AKI 1 had inadequate care as per the audit standards but did not lead to progression in AKI. All patients with AKI 2 and 3 were referred to the renal team.
Discussion: This audit showed a third of the patients with AKI 1 had delayed recognition and thus deficiencies in their care. The findings supported setting up of an AKI e-alert system. An alert is now automatically generated against the patients name on the handover sheet. We have now set up training about the alert system and management of AKI based on the ABCDE approach ³ with a re-audit in due course.
Dr Jacobson graduated from University of Melbourne 2016.Completed internship at GV health Shepparton and currently working as a HMO in Medicine.He has an interest in Acute kidney Injury.