A Multifaceted Quality Improvement Programme to Improve Acute Kidney Injury Care and Outcomes in a Large Teaching Hospital.

Acute kidney injury (AKI) is now widely recognised as a serious health care issue, occurring in up to 25% of hospital in-patients, often with worsening of outcomes. There have been several reports of substandard care in AKI. This quality improvement (QI) programme aimed to improve AKI care and outcomes in a large teaching hospital.

Assessing and documenting fluid balance.

Concerns about inadequate patient hydration and suboptimal monitoring of fluid balance have been documented in recent reports. The Fluid Balance Improvement Project at Central Manchester University Hospitals NHS Foundation Trust was undertaken to identify risk factors influencing hydration and to implement a revised process to manage these risks, resulting in the development of a hydration pathway. This new approach to monitoring patient hydration, together with staff education and support, has resulted in improved compliance with fluid balance monitoring standards, as well as significant improvements in identifying patients at risk of dehydration, and an increase in patients with acute kidney injury commencing appropriate fluid balance monitoring.