PT  - JOURNAL ARTICLE
AU  - Jennifer Joslin
AU  - Hannah Wilson
AU  - Daniel Zubli
AU  - Nathan Gauge
AU  - Mark Kinirons
AU  - Adrian Hopper
AU  - Taryn Pile
AU  - Marlies Ostermann
TI  - Recognition and management of acute kidney injury in hospitalised patients can be partially improved with the use of a care bundle
AID  - 10.7861/clinmedicine.15-5-431
DP  - 2015 Oct 05
TA  - Clinical Medicine
PG  - 431--436
VI  - 15
IP  - 5
4099  - http://www.rcpjournals.org/content/15/5/431.short
4100  - http://www.rcpjournals.org/content/15/5/431.full
SO  - Clin Med2015 Oct 05; 15
AB  - 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.