Abstract

Background

Acute kidney injury (AKI) is a common complication among oncology patients and results in significant morbidity and mortality. However, good quality care for AKI patients remains difficult to achieve in the hospital setting. This quality improvement project aims to develop a multifaceted approach to enhance care and improve outcomes for cancer inpatients with acute kidney injury.

Method

Baseline data on the quality of AKI care was obtained before (August 2017) and after (January 2019) a 2-year implementation duration of interventions in a major cancer centre which include:

• Introduction of a dedicated AKI team comprising of 1 acute physician and 2 specialist AKI nurses.
• Training and education amongst healthcare staff via AKI awareness week, development of a tailored AKI proforma, educational posters and e-learning resources.
• Electronic system optimisation enabling live detection of stage 2/3 AKI development in patients by AKI team, allowing the mandating of AKI care bundles remotely that can be completed by ward staff.

Main outcomes assessed were improved rapid assessment of AKI, increased consistency in clinical review and reduction in length of hospital stay.

Results

Significant improvement in AKI care quality has been observed post intervention, summarised in the table below.

August/September 2017

Jan/Feb 2019

No of patients with AKI 2/3

40

24

Was AKI risk recognition bundle used?

32.5%

75%

Was an AKI risk assessment undertaken within 24 hours?

62.5%

70.8%

Was an assessment made and a conclusion recorded for the patient fluid status within 24 hours?

75%

91.7%

Was the patient reviewed by a senior doctor within 12 hours of the beginning of this episode of care?

67.5%

95.8%

Was the patient’s medication reviewed either before or immediately after AKI detected?

60%

91.7%

Length of stay

18.5 days

11.2 days

Conclusion

A comprehensive, multifaceted approach is beneficial in improving care for oncology inpatients with stage 2/3 AKI.