123 Optimising Pre-Operative Intravenous Fluids to Reduce the Incidence of Acute Kidney Injury in Hip Fracture Patients
N Ng, T Smith, J M Leow, M Williams- Surgery
Abstract
Aim
Acute kidney injury (AKI) in hip fracture patients is associated with increased morbidity, mortality, and hospital stay. Local policy recommends 500ml of Plasmalyte on admission to the Emergency Department (ED), followed by another 500ml at 100ml/hr. Subsequently, patients without AKI should receive maintenance fluids until post-operative oral fluid intake is adequate. IV fluid (IVF) prescriptions in line with local policy were defined as ‘adequate’.
Method
Three prospective audits were undertaken with interventional measures deployed between cycles. Data collected included blood results, IVF received, past medical history, and the pre/post-operative incidence of AKI. Interventions include an ED proforma used as an admission checklist and educating ward doctors with a narrated video and posters.
Results
None of the twelve patients in the first cycle received adequate IVF. The second and third cycles had twenty-seven and twenty-eight patients, respectively. Between these cycles, ED’s IVF prescription adherence improved from 37.0% (10/27) to 46.4% (13/28). On the wards, IVF prescription adherence significantly improved from 33.3% (9/27) to 78.5% (22/27). Pre-operative AKI was 3.7% (1/27) in the second cycle and 0% (0/28) in the third cycle. Post-operative AKI was 3.7% (1/27) in the second cycle and 7.1% (2/28) in the third cycle. None of the post-operative AKI patients received adequate IVF. The third cycle showed that the primary Plasmalyte and secondary Plasmalyte were prescribed appropriately in 57% and 50% of patients, respectively.
Conclusions
Our interventions successfully improved IVF prescriptions on the wards. However, adherence can be further improved to local policy to reduce the incidence of AKIs.