Davies Andrew, Srivastava Seema, Seligman William, Motuel Lorraine, Deogan Vardeep, Ahmed Shaza, Howells Nicholas
Department of Orthopaedics, North Bristol NHS Trust, Bristol, UK.
Department of Geriatric Medicine, North Bristol NHS Trust, Bristol, UK.
BMJ Open Qual. 2017 Nov 25;6(2):e000006. doi: 10.1136/bmjoq-2017-000006. eCollection 2017.
Acute kidney injury (AKI) is associated with increased patient morbidity, mortality and an extended hospital stay. The financial burden to the National Health Service is high and it can affect up to one in five inpatients. Optimal fluid balance management is essential for the prevention of AKI and this can be particularly challenging in the patient with trauma. Our aim was to reduce the rate of AKI in patients with traumatic injuries in the regional trauma centre. We developed new fluid balance charts and documented how well these were completed. The number of AKI alerts per month was calculated on our pathology system. Scenario training was delivered at handover meetings and an e-learning tool was designed at three levels: healthcare assistants; nurses; and medical staff, dietetics and pharmacists. Educational posters were placed in clinical areas and patient information leaflets produced. Junior doctors were regularly informed of AKI rates on the ward. The number of AKI alerts on our trauma ward declined from 50 in January 2016 to 19 in November 2016. The mean monthly rate of AKI fell 33% following the invention (P<0.001). Completion of fluid balance charts improved; 6 hourly urine output documentation increased from 36% to 68% and running 1 hourly output increased from 80% to 96%. Calculation of total daily fluid balance rose from 12% to 72%, before decreasing to 32%. This highlighted the need for continued encouragement. Improved fluid balance monitoring led to a reduction in the prevalence of AKI in patients admitted to this trauma centre.
急性肾损伤（AKI）与患者发病率、死亡率增加以及住院时间延长相关。对国民医疗服务体系造成的经济负担高昂，且可能影响多达五分之一的住院患者。优化液体平衡管理对于预防AKI至关重要，而这在创伤患者中可能极具挑战性。我们的目标是降低区域创伤中心创伤患者的AKI发生率。我们制定了新的液体平衡图表，并记录其完成情况。通过我们的病理系统计算每月的AKI警报数量。在交接班会议上进行情景培训，并设计了一个针对三个层级的电子学习工具：医疗辅助人员、护士以及医务人员、营养师和药剂师。在临床区域张贴教育海报并制作患者信息传单。定期向初级医生通报病房的AKI发生率。我们创伤病房的AKI警报数量从2016年1月的50例降至2016年11月的19例。发明之后，AKI的平均月发生率下降了33%（P<0.001）。液体平衡图表的完成情况有所改善；每6小时尿量记录从36%增至68%，每小时尿量记录从80%增至96%。每日总液体平衡的计算从12%升至72%，之后降至32%。这凸显了持续给予鼓励的必要性。改善后的液体平衡监测使该创伤中心收治患者的AKI患病率降低。
