Recommended Citation
Briggs T. Nurse driven intervention to improve acute kidney injury (AKI). Evidence Based Practice poster presentation at Empowering Nursing Excellence: Recognizing the Value and Impact of Nurses, Advocate Health Midwest Region Nursing Research & Professional Development Conference 2023; November 15, 2023; virtual.
Presentation Notes
Evidence Based Practice poster presentation at Empowering Nursing Excellence: Recognizing the Value and Impact of Nurses, Advocate Health Midwest Region Nursing Research & Professional Development Conference 2023; November 15, 2023; virtual.
Abstract
Background and/or rationale
Acute kidney injury (AKI) following the use of contrast agents is a known complication of coronary angiography. The National Cardiovascular Data Registry (NCDR) defines AKI as an acute increase of > 0.3mg/dl or a 50% or greater increase in the serum level of creatinine from baseline and cardiac patients are at high risk for AKI. At a Midwest quaternary medical center, the risk adjusted AKI rate was 8.63% (Q3, 2021) which is above the national average of 3.46% (NCDR).
Aim or purpose of the initiative
The purpose of this project was twofold: 1) Increase nurse’s knowledge about oral and intravenous hydration for cardiac catheterization patients 2) Decrease acute kidney injury for elective percutaneous coronary interventions
Implementation plan
Cardiac step-down unit patients who underwent procedures in Interventional Cardiology were given instructions to drink 64 oz water pre- and post-procedure. Nursing staff on the cardiac step-down units were given targeted education regarding oral hydration and tested with pre-education and post-education survey.
Outcomes
Pre intervention included inpatients who underwent cardiac catheterization in July and August 2021(n=307) compared with post intervention patients in July and August 2022 (n=293). Evaluation for AKI increased from 87.6% to 91.5% following cardiac catheterization procedures. Mann Whitney U test showed statistical differences between median pre intervention oral fluid intake 322ml (range: 40-1360) and post intervention median oral fluids 395ml (range: 60-2780) (p=0.02). Other variables tracked that increased from pre to post were intravenous pre procedure fluids, post procedure oral fluids, and documentation of intake and output. Nurse knowledge increased from pre to posttest regarding intravenous hydration (9%) and oral hydration (27%).
Implications for practice
Further education and monitoring on the importance of intravenous and oral hydration in the pre and post-cardiac catheterization patients is needed for the prevention AKI.
Document Type
Poster
Publication Date
11-15-2023
Nurse driven intervention to improve acute kidney injury (AKI)
Background and/or rationale
Acute kidney injury (AKI) following the use of contrast agents is a known complication of coronary angiography. The National Cardiovascular Data Registry (NCDR) defines AKI as an acute increase of > 0.3mg/dl or a 50% or greater increase in the serum level of creatinine from baseline and cardiac patients are at high risk for AKI. At a Midwest quaternary medical center, the risk adjusted AKI rate was 8.63% (Q3, 2021) which is above the national average of 3.46% (NCDR).
Aim or purpose of the initiative
The purpose of this project was twofold: 1) Increase nurse’s knowledge about oral and intravenous hydration for cardiac catheterization patients 2) Decrease acute kidney injury for elective percutaneous coronary interventions
Implementation plan
Cardiac step-down unit patients who underwent procedures in Interventional Cardiology were given instructions to drink 64 oz water pre- and post-procedure. Nursing staff on the cardiac step-down units were given targeted education regarding oral hydration and tested with pre-education and post-education survey.
Outcomes
Pre intervention included inpatients who underwent cardiac catheterization in July and August 2021(n=307) compared with post intervention patients in July and August 2022 (n=293). Evaluation for AKI increased from 87.6% to 91.5% following cardiac catheterization procedures. Mann Whitney U test showed statistical differences between median pre intervention oral fluid intake 322ml (range: 40-1360) and post intervention median oral fluids 395ml (range: 60-2780) (p=0.02). Other variables tracked that increased from pre to post were intravenous pre procedure fluids, post procedure oral fluids, and documentation of intake and output. Nurse knowledge increased from pre to posttest regarding intravenous hydration (9%) and oral hydration (27%).
Implications for practice
Further education and monitoring on the importance of intravenous and oral hydration in the pre and post-cardiac catheterization patients is needed for the prevention AKI.
Affiliations
Aurora St. Luke’s Medical Center