64THE REDUCTION OF THE INCIDENCE OF ACUTE KIDNEY INJURY (AKI) IN ELDERLY PATIENTS IN A REHABILITATION HOSPITAL

Abstract

Introduction: Acute Kidney Injury (AKI) is a rapid rise in the level of serum creatinine (>26 umol/L or >1.5x baseline) or a significant, sudden drop in urine output (<0.5 ml/kg/ hr for 6 consecutive hours). It is independently responsible for mortality (up to 4x increased risk) and frail elderly patients are at increased risk of developing AKI. Method(s): I conducted an audit in 2014 in the community elderly rehabilitation hospital to see how many inpatients developed AKI over an 8 week period. The result was 10 new cases of AKI in that period: 1 in AKI Stage 1, 6 in AKI Stage 2 and 3 in AKI Stage 3. Intervention(s): Following the audit, I aimed to reduce the incidence of AKI by at least 30% for the same time period in 2015. To facilitate this, I increased the awareness of risk of AKI and options for identification and monitoring and offered guidance on fluid intake/output recommendations per weight for patients via one-on-one conversations with ward doctors and nursing staff. I also arranged a teaching session on AKI for the ward doctors and attended the ward managers' meetings to address AKI risk and the need for prevention and early identification. Result(s): The re-audit was conducted in 2015 during the same time frame. The result was 5 new cases of AKI in that period; all 5 were in AKI Stage 1 with no newly diagnosed AKI Stage 2 or 3. The incidence of AKI was reduced by 54% (exceeding the 30% goal) suggesting improved prevention. The fact that there were no newly diagnosed severe AKI suggested there was also early recognition. Conclusion(s): In order to confirm that the results were in fact due to the increased awareness and not just chance alone, I used the Mann Whitney U test to compare the nominal input (educational intervention) with the quantitative non-normal outcome (cases of AKI 2014 vs 2015). The results were inputted on an online calculator: the U value = 2.5 with a p value of < 0.05 and the Z score = 2.6944 with a p value of 0.00714. The Z score shows that the difference between the cases of AKI in 2014 and 2015 is more than just a random occurrence, with the p value confirming that the results were statistically significant.