Summary of acute kidney injury (AKI) quality standard and statements, process measures and core elements of a care bundle5 10 13 42
| NICE Quality standard for AKI (QS76) 2014 | Advancing quality AKI clinical process measures 2015 | Think Kidneys Core elements of AKI care bundle 2015 |
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Statement 1: People who are at risk of acute kidney injury are made aware of the potential causes. Statement 2: People who present with an illness with no clear acute component and one or more indications or risk factors for acute kidney injury are assessed for this condition. Statement 3: People in hospital who are at risk of acute kidney injury have their serum creatinine level and urine output monitored. Statement 4: People have a urine dipstick test performed as soon as acute kidney injury is suspected or detected. Statement 5: People with acute kidney injury have the management of their condition discussed with a nephrologist as soon as possible, and within 24 hours of detection, if they are at risk of intrinsic renal disease or have stage III acute kidney injury or a renal transplant. Statement 6: People with acute kidney injury who meet the criteria for renal replacement therapy are referred immediately to a nephrologist or critical care specialist. |
AKI-01 Urine dipstick test within 24 hours of first AKI alert AKI-02 Stop ACE inhibitor and angiotensin receptor blockers (ARBs) within 24 hours of first AKI alert AKI-03 Serum creatinine test repeated within 24 hours of first AKI alert AKI-04 Ultrasound scan within 24 hours of first alert AKI-05 Specialist renal/critical care discussion within 12 hours of first AKI alert AKI-06 Give patients written self-management information prior to discharge AKI-07 Pharmacy medication review—data collection measure only |
Initial assessment ABCDE as assessment* (follow NICE CG50†) observations—check NEWS Score‡ Look for signs of sepsis Abdominal palpation looking for full bladder Initial treatment Prompt treatment of sepsis (start Sepsis Six care bundle) Fluid challenges if hypovolaemic/hypotensive Medication review Stop potentially harmful drugs Check for dose adjustments in AKI Relieve obstruction (see guidance) |
*A method for assessing each of a patient’s vital systems—Airway, Breathing, Circulation, Disability and Exposure.
‡National Early Warning Score: https://www.england.nhs.uk/ourwork/clinical-policy/sepsis/nationalearlywarningscore/.
NICE, National Institute for Clinical Excellence.