Acute Kidney Injury Care Bundles

Abstract

Acute kidney injury (AKI) is a common complication that occurs in hospitalized patients and appears susceptible to a wide variability in practice. This may lead to suboptimal quality of care. The concept of a ‘care bundle' for AKI has been proposed to improve the reliability and quality of care. A bundle is designed to be a structured method of improving care processes and outcomes. It contains a small set of evidence-based practices intended for a defined population and care setting. The Institute for Healthcare Improvement has developed guidelines for the design of care bundles. Care bundles for critically ill patients focusing on mechanical ventilation, central venous catheters, and sepsis have been widely implemented with modest success in terms of compliance and impact on care processes and outcomes. A care bundle for AKI is highly desired, given the observed practice variation and indication of poor care for AKI patients; however, existing proposals are too comprehensive and have not been focused on a defined population at-risk, clinical context or setting. They have also not engaged local stakeholders in the process.

Patient Blood Management Bundles to Facilitate Implementation

“…In other fields of complex interdisciplinary medicine, for example, intensive care medicine, similar barriers could be observed. To overcome these barriers, care bundles have been widely implemented with success in terms of compliance to guidelines and beneficial impact on care processes and outcomes [27][28][29][30][31]. Thus, a bundle for PBM is highly desired.…”

A nonsurgical and nonpharmacological care bundle for preventing upper urinary tract damage in patients with spinal cord injury and neurogenic bladder

“…The protocol has been effective in reducing the incidence of VAP and decreasing length of stay in an intensive care unit (McCarron, ). Moreover, other bundles, such as the central line bundle, pressure injury prevention bundle, and acute kidney injury care bundle, have also been developed and proven to be effective in improving patients' outcomes (Bagshaw, ; Coyer et al, ; McCarron, ; Pronovost et al, ). Researchers have paid increasing attention to UUTD in patients with spinal cord injury and neurogenic bladder, but thus far, achievements in this area have been limited, especially in the prevention of UUTD in this patient group.…”

“…A particular care bundle is different from other interventions because it must have clear regional and medical environmental suitability. In addition, a care bundle should be targeted, and all the interventions should be recognized and easily mastered by health care professionals in clinical settings (Bagshaw, ). Therefore, development of a care bundle should use easy‐to‐implement scientific methods that are critical to clinical practices.…”

Care Bundles for Acute Kidney Injury: Do They Work?

“…Compliance is measured with an ‘all or none' approach; partial completion of a CBs counts as ‘none' [9]. It is also apparent that a CB is not a single intervention but rather a number of independent elements (usually between 3 and 6) that are delivered together as a complex intervention.…”

“…One of the attractions of a CB is that it can encompass the wider multi-disciplinary team as opposed to exclusively focussing on physicians, and anecdotally we have found this to be a significant enabler to CB usage. The principles that underpin CB usage in AKI have been summarised in a recent review article [9], so here we undertake a more focussed review of recent evidence around their effectiveness.…”