Table 2

Summary of acute kidney injury (AKI) quality standard and statements, process measures and core elements of a care bundle5 10 13 42

Quality standard for
AKI (QS76) 2014
Advancing quality
AKI clinical process measures 2015
Think Kidneys
Core elements of AKI care bundle
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)