MP222INTRODUCTION AND USAGE ASSESSMENT OF A FIRST GENERATION AKI CHECKLIST BUNDLE

Abstract

Introduction and Aims: Up to 20% of patients admitted to UK hospitals will have AKI of some degree (Wang et al, 2012), with a cost of over 400,000,000 to the National Health Service (NICE, 2014). A National Confidential Enquiry into Patient Outcome and Death report estimated that up to a third of inpatient deaths contributed to by AKI have the potential to be prevented, and summarised failings in the recognition, management and referral of AKIs (NCEPOD, 2009). The AKI Prevention Programme, a collaboration between NHS England and the UK Renal Registry, recommend an AKI Checklist Bundle to aid the initial investigation and treatment of AKI, as well as elicit appropriate nephrology referral. Method(s): We developed an automated, real-time electronic AKI checklist. This is based on the London AKI Care Bundle and initiated by the already present electronic AKI alert system. Data was collected via the trust intranet and analysis of the checklist completion rates for each AKI stage (as defined by the AKIN classification system) was undertaken. Result(s): This study included a total of 490 AKI Checklists over a period of 2 months. The total number of checklists initiated per AKI stage was: AKI 1 n=341, AKI 2 n=94, AKI 3 n=55. The percentage of checklists completed per stage was AKI 1 = 40%, AKI 2 = 50.8%, AKI 3 = 59.2%. Conclusion(s): Despite the 'pop-up' function and necessity to actively decline the checklist launch, completion rate of the AKI checklist remains below optimal across all 3 stages. These findings show that further qualitative investigation into the cause of lower completion rates is required. The overarching hypothesis for this future research is the concept of checklist fatigue. This is a phenomenon of immediate importance as the number of both paper and, increasingly, electronic checklists become engrained in inpatient care. An analysis of checklist fatigue (Grigg, 2015) highlighted the preservation of professional autonomy and dynamic development to increase efficiency as the most important factors. The paper reinforced that education of healthcare professionals to create a 'checklist culture' is paramount for success. If individuals consider the checklist to be non-beneficial to their practice, the compliance is likely to be poor. In terms of education as an integral factor in checklist completion, a recent quality improvement project undertaken at a hospital in the UK found that multidisciplinary education increased implementation of AKI checklist steps by almost 50% (Forde et al, 2016). The gold standard combination of education, detection and intervention (including streamlined nephrology referral), as described by the collaborative AKI programme, necessitates an AKI checklist. Implementation of a combined multidisciplinary education element at local level, and assessment of the impact on this AKI checklist completion rate is planned.