Forde Caroline, McCaughan Jennifer, Leonard Niall
BMJ Qual Improv Rep. 2012 Dec 18;1(1). doi: 10.1136/bmjquality.u200370.w326. eCollection 2012.
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.
急性肾损伤（AKI）是一个常见且严重的问题，目前发现其治疗情况不佳。早期识别并采取行动对于可能减缓或逆转其病程以及促进及时转诊至专科服务至关重要。在这个质量改进项目中，一家地区综合医院引入了多学科教育课程以及一个用于辅助AKI管理的简单“ABCDE”检查表。在全院范围内对AKI的发病率（定义为肌酐升高26umol/l）、其识别情况及管理情况进行了测量。通过对整个多学科团队进行培训，以识别三个关键的早期预警信号，从而提高了对AKI的识别：血清肌酐升高、24小时尿量<500毫升以及收缩压<90mmHg。引入“ABCDE”检查表（处理药物、提升血压、计算液体平衡、检测尿液、排除梗阻）以推动AKI管理。最初在一个试点病房为医生、护士、护理助理和药剂师开展了为期四周的教育项目。对AKI的识别情况以及“ABCDE”检查表的实施情况进行了测量。在项目引入之前，16%的患者发生了AKI，但仅31%的病例在24小时内得到识别，且仅20%的病例实施了80%的“ABCDE”步骤。经过多学科教育后，AKI的识别率提高到了100%，67%的病例实施了80%的“ABCDE”步骤。当该项目在外科病房（120张床位）和40张床位的内科住院单元推广时，这些结果得到了重现。AKI的预防和治疗应成为所有临床工作人员的核心能力。对多学科团队进行教育并使其有能力实施简单的干预措施可提高标准，并且应成为针对AKI的策略基础。通过这项研究，已证明在AKI的识别和管理方面有显著改善，对患者安全、护理质量以及患者和工作人员的体验产生了积极影响。
