AKI alerts on ICE at the Luton and Dunstable Hospital

AKI E-alerts at the L&D E-alerts for AKI stages 1, 2 and 3 are based on the change in serum creatinine result from the previous result E-alerts are automatically generated by ICE Follow the instructions and clear the alert

Acute Kidney Injury E-alerts Stage Increase in serum Creatinine 1 1.5 x previous result 2 2 x previous result 3 ≥3 x previous result

Limitations of the AKI e-alert system Multiple alerts will show if AKI alert is for stages 2 or 3 ALWAYS accept the highest ranking alert eg. AKI stage 3 alert; AKI stage 1 & 2 alerts also show eg. AKI stage 2 alert; AKI stage 1 alert will also show AKI alerts are based on the change in serum creatinine from the previous result which may NOT reflect the patient’s true baseline You have to go to the patient’s results on ICE in order to see the e-alert

Limitations of the AKI e-alert system The severity of AKI may be missed if there are multiple serum creatinine results within a short time period Eg. Over 24 hours a patient’s serum creatinine (umol/L) changes as follows: 100 -> 151 AKI stage 1 alert 151 -> 228 AKI stage 1 alert 228 -> 343 AKI stage 1 alert The change in serum creatinine from the previous result is only >1.5 therefore generating an AKI stage 1 alert HOWEVER the change in serum creatinine from the first to the last result is >3 indicating the patient has AKI stage 3 Always review the trend in serum creatinine when assessing patient’s for AKI

Limitations of the AKI e-alert system AKI alerts may be generated and the patient does not have AKI Eg. Over 24 hours a patient’s serum creatinine (umol/L) changes as follows: 100 -> 60 No alert 60 -> 98 AKI stage 1 alert 98 -> 101 No alert The second result is not in keeping with the patient’s baseline An AKI stage 1 alert is generated as the change from the previous result of 60 umol/L was >1.5. The change was a return to the patient’s baseline Always review the trend in serum creatinine when assessing patient’s for AKI

What should I do when I see an AKI alert on ICE?

The AKI alert on ICE Colour tells you the severity of the alert Alert symbol

1. Click on the alert symbol

2. All alerts on the patient are displayed

AKI stage 3 > AKI stage 2 > AKI stage 1 4. Follow instructions for highest ranking alert AKI stage 3 > AKI stage 2 > AKI stage 1

5. To acknowledge an alert: Click on ‘Clear’ next to the alert

IMPORTANT Once you have seen an AKI alert please follow the instructions on the alert Follow instructions for the HIGHEST ranking alert (AKI stage 3 > AKI stage 2 > AKI stage 1) Please clear ALL AKI alerts on the patient at that time

Further Information AKI Documents on intranet Trust AKI guidelines Trust AKI Management Care Bundle AKI prevention e-learning