ACUTE KIDNEY INJURY PROJECT
Issue: Acute Kidney Injury (AKI)
Project Description: Memorial Hospital of Union County has partnered with the Ohio
Hospital Association through CMS on a Leading Edge Advanced Practice Topic
(LEAPT) project to establish best practices for earlier detection and better management
of AKI in the community hospital setting.
Results: We implemented a morning SCr “Delta Report” from the lab to print out every
morning on each nursing unit with all patients listed who had a >0.3 change in their SCr
level. Nursing will notify the attending physician of an increase in SCr of >0.3, a GFR
<40, or if the urine output is <30 mls/hr. The physicians will assess volume status and
order pre and/or post isotonic IV fluids, if clinically indicated (before and after contrast,
surgery, or other procedures). The pharmacist and physicians will assess for nephrotoxic
medications and other renally excreted drugs that require dosage adjustments for AKI.
Within 24 hours of the assessment of AKI, the physician will stop nephrotoxic
medications, order a UA, urine sodium, urine creatinine, and urine eosinophil, order a
renal ultrasound (if clinically indicated) and discuss the case with a Nephrologist or
nephrology specialist and document this in the medical record. Upon discharge, we will
provide education to patients who may have residual renal dysfunction due to their AKI
(medications, diet, signs, symptoms, follow-up, etc.).
Lessons Learned: We learned that our physicians are not documenting the cause or the
suspected cause of AKI in the medical record100% of the time. We will work with the
medical staff to achieve our goal of 100% compliance with this documentation.
We identified two areas for improvement within the Radiology Department. We found
the patients’ previous imaging contrast exposures were not monitored closely enough.
As a result, we revised our Contrast Screening Form for imaging to ask the patients when
they last received any contrast. We also discovered that the Radiology Department did
not have a system in place to notify the Pharmacy Department when a patient received
contrast for an imaging study. As a result, we are creating a report that will tell the
Pharmacy personnel when an inpatient receives contrast. This will allow the Pharmacists
to have a more complete picture of our patients and their risk for developing or
worsening AKI.
Submitters:
Amy Stephens, RN from Memorial Hospital of Union County
(amy.stephens@memorialhosp.org)
Beth Johnson, RN, BSN from Memorial Hospital of Union County
(beth.johnson@memorialhosp.org)