Mitigating AKI – The Struggle is REAL- 2024 Quality Summit Presentation (Non-CE)-Mitigating AKI

Video Transcription

Video Summary

The session "Mitigating AKI: The Struggle is Real" presented by Patricia (Patty), Danielle, and Jacob from Ohio State University Wexner Medical Center, focused on a quality improvement initiative aimed at reducing acute kidney injury (AKI), particularly associated with contrast procedures. The multi-disciplinary team tackled this challenge over several years, striving to improve their AKI rates from less than the 25th percentile to surpassing the 90th percentile.<br /><br />Key initiatives included implementing a pre-cath risk assessment tool, adjusting contrast thresholds, utilizing an LVEDP-guided hydration protocol, and switching to a lower osmolarity contrast agent. Despite these measures, initial efforts did not significantly alter AKI rates, prompting further investigation into workflow efficiency and documentation practices.<br /><br />Jacob, a medical student, spearheaded a quality project to identify process barriers after PCI, particularly focusing on hydration protocols. His analysis highlighted the importance of timely and complete hydration as significant factors in preventing AKI, revealing common delays and discrepancies in charting hydration orders.<br /><br />To resolve these issues, actions included improving nursing education regarding hydration protocols, changing bag sizes for hydration to prevent premature termination of fluids, refining documentation protocols for physicians, and conducting more concurrent quality reviews. These changes contributed to enhancing hydration protocol adherence and thus mitigating AKI.<br /><br />Ultimately, through a dedicated, iterative process and addressing process inefficiencies, the team achieved notable success, sustaining metrics at the 90th percentile for six consecutive quarters, demonstrating significant progress in managing and preventing AKI.

Keywords

acute kidney injury

quality improvement

hydration protocol

PCI procedures

LVEDP

nursing education

electronic health record

multidisciplinary team

performance metrics

healthcare quality

contrast procedures

risk assessment

Ohio State University

process barriers

documentation practices

medical center