Development of Practice Guidelines for Prevention of Post-Operative Acute Kidney Injury in Critically Ill Surgical Patients
Keywords:
Acute kidney injury, Clinical practice guidelines, Critically ill patient, Post-operative, Prevention, Surgical patientsAbstract
Postoperative acute kidney injury (PO-AKI), a common complication in critically ill surgical patients, is complex and has various preventive steps, resulting in inconsistent nursing practices. Therefore, developing standardized practice guidelines for nurses is necessary. The objective of this study was to develop clinical practice guidelines for the prevention of PO-AKI in critically ill surgical patients. The framework is based on The ADAPTE Collaboration. Participants were divided into two groups: 1) five postoperative critically ill surgical patients who trialed the guidelines (n = 5), and 2) nineteen nurses who implemented the guidelines (n = 19). Research instruments included 1) a guideline screening form, 2) a guideline quality assessment form, and 3) a form to collect results of the effectiveness of using the guideline in clinical and process aspects. The guideline development had three phases: 1) the set-up phase, 2) the adaptation phase, and 3) the finalization phase. Data were analyzed using descriptive statistics.
The study findings resulted in clinical practice guidelines for the prevention of PO-AKI, which comprise six categories including 1) definition, diagnostic criteria and severity classification of PO-AKI, 2) guidelines for assessing risk, 3) nursing intervention guidelines, 4) guidelines for monitoring and reducing kidney damage, 5) monitoring and following-up guidelines, and 6) health education for patients and caregivers. The guidelines were assessed for quality using the AGREE II tool, with a total score of 93.09%. All nurses who tested the guidelines agreed they were feasible for preventing PO-AKI and could perform all items with an overall satisfaction score of 4.16. The highest average score for practical application in the organization was 4.79, and the lowest average satisfaction score in the aspect of ‘the practice could be easily followed and not complicated’ was 3.95.
These guidelines should be implemented and studied for their effectiveness in clinical and procedural outcomes.
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