An audit of acute kidney injury preventative care in patients with hip fracture

An audit of fluid balance monitoring in patients with fractured neck of femur found declining compliance, completion and accuracy following the introduction of National Early Warning Score 2, potentially increasing the risk of acute kidney injury in an already vulnerable patient population. The findings highlight the need for improved acute kidney injury prevention strategies and suggest that the implementation of a validated acute kidney injury risk score may help enhance patient outcomes across trauma and orthopaedic settings. Background: Despite the increasing incidence of acute kidney injury in hospitalised patients, urine output monitoring has been excluded from the National Early Warning Score since its introduction in November 2018. It is unclear what the impact of this has on acute kidney injury risk. Aims: To ascertain if the introduction of National Early Warning Score has impacted on acute kidney injury preventative care for patients with a fractured neck of femur and whether they are receiving optimal care. Methodology: A retrospective audit of patients with a fractured neck of femur with an acute kidney injury was carried out, pre- and post-National Early Warning Score implementation. Patients were assigned an acute kidney injury risk score and acute kidney injury preventative care was assessed. Results: While some aspects of acute kidney injury were adhered to in both groups, fluid balance compliance was significantly lower in the post-National Early Warning System group. Conclusion: Changes in NEWS2 may contribute to the poor recognition of acute kidney injury, leaving patients at risk of further deterioration from lack of fluid balance monitoring.