Acute Kidney Injury: It’s as easy as ABCDE

Abstract

Acute kidney injury (AKI) is a common, serious problem which has been found to be poorly managed. Early recognition and action is critical in potentially slowing or reversing its course and facilitating timely referral to specialist services. In this quality improvement project, multidisciplinary education sessions and a simple ‘ABCDE’ checklist to aid AKI management were introduced in a district general hospital. The incidence of AKI (defined as 26umol/l rise in creatinine), its recognition and management were measured hospital wide. AKI recognition was improved by educating the entire multidisciplinary team to identify three key early warning signs: a rise in serum creatinine, urine output of <500mls in 24 hours and systolic blood pressure of <90mmHg. The ‘ABCDE’ checklist (Address drugs, Boost blood pressure, Calculate fluid balance, Dip urine, Exclude obstruction) was introduced to prompt AKI management. A four week educational programme was delivered, initially on a pilot ward, to doctors, nurses, nursing assistants and pharmacists. AKI recognition and implementation of the ‘ABCDE’ checklist were measured. Prior to project introduction 16% of patients developed AKI, but were recognised within 24 hours in only 31% of cases, with 80% of ‘ABCDE’ steps implemented in only 20%. Following multidisciplinary education, AKI recognition improved to 100%, with 80% of ‘ABCDE’ steps implemented in 67% of cases. These results were replicated when the project was rolled out across the surgical directorate (120 beds) and in the 40 bed medical admission unit. Prevention and treatment of AKI should be a core competency of all clinical staff. Educating and empowering the multidisciplinary team to implement simple interventions improves standards and should be the foundation of strategies targeting AKI. Through this study significant improvements have been demonstrated in AKI recognition and management, positively impacting on patient safety, quality of care and patients' and staff experience.

Assessment of knowledge of acute kidney injury among non-nephrology doctors in two government hospitals in Ondo City, Southwest, Nigeria

“…This therefore implies that educational programs aimed towards improvement of AKI patients' care should be targeted at all doctors irrespective of their years of practice or specialty. Focused educational programs on improving knowledge and management of AKI have been reported to improve management of AKI and overall patients' outcomes (23–26). …”

A nurse‐led intervention improves detection and management of AKI in Malawi

“…It was designed based on combined (but extensive) experiences in AKI and clinical management from the UK and Malawi to create a local pragmatic tool for education taking into account some of the known barriers to education in this particular setting as described in the introduction. Articles such as 'AKI:its easy as ABCDE' (Forde et al 2012) and 'The role of the nurse in the management of AKI' (Murphy & Byrne 2010) were a useful reference points for our idea, but others such as Xu et al (2014) were published after our study had begun. There are no comparators to this work in Malawi or sub-Saharan Africa and this remains the only such study at the time of submission but we hope that this work will be built on.…”

Does Your Program Know Its AKI and CRRT Epidemiology? The Case for a Dashboard

“…The early recognition of AKI has been associated with improved patient outcomes. Forde and colleagues report earlier diagnosis of AKI and improvement AKI management following targeted education and implementation of a checklist (13). The AKI checklist/bundle uses a simple acronym ABCDE; Address drugs, Boost blood pressure, Calculate fluid balance, Dip urine, and Exclude obstruction (13).…”