Acute Kidney Injury (AKI) is a major cause of harm. 1 in 5 emergency admissions into hospital have AKI and there are delays in recognising AKI which develop in hospitals in around 43% of cases. All patients are at risk but it is known that around 20-30% of AKI cases are avoidable. AKI is estimated to account for 12,000 unnecessary deaths a year. Prevention of 20% of cases would pay salaries and overheads for 20 to 30 extra nurses at every acute Trust.
The Improvement Academy have been supporting Bradford Teaching Hospitals NHS Foundation Trust (BTHFT) to test a package of interventions to improve the recognition, enhance awareness and understanding and improve basic elements in quality of care received by patients with AKI.
With longer term aims to impact on 30 day mortality, incidence of hospital AKI, incidence of AKI progression, length of stay, and proportion of AKI patients with renal recovery by discharge.
BTHFT chose to pilot their care bundle (a set of evidence-based actions that when used together significantly improve patient outcomes) and focused education on one double ward during their three month implementation period. This allowed the team to make timely changes to the process and care bundle with feedback and suggestions from the ward staff before spreading what had worked more widely across the Trust.
What we found
- The ward staff were good at recognising and treating the sickest patients with AKI.
- There were some gaps in knowledge for all staff groups surrounding AKI. Nursing staff produced wall displays to help inform colleagues of the importance of AKI and the team developed a ‘resource pack’ containing information and articles about AKI.
- Some staff expressed a lack of confidence in explaining their AKI episode to patients. The team developed a patient leaflet to be used in these discussions with patients.
- Communicating a patient had AKI to all members of the team was not always done. The team were able to build in prompts and reminders into their processes to ensure this information was shared throughout the MDT
Testing the interventions in practice taught us some elements of care were happening, but not all. Showing which elements were not done reliably so changes and improvements could be made.
The education programme, when tested taught us that one to one coaching was also sometimes needed, with live cases worked through and case studies developed.
Peer support was crucial, nurses teaching nurses, clinical leadership fellows supporting junior medical staff and key support from senior clinicians.
- Spreading to further wards
- Sharing findings with other acute Trusts
- Exploring how to use key staff in organisations to sustain the work
“A review meeting at the end of the first three months of AKI interventions at Bradford has been extremely valuable, congratulations to the Bradford team on all of their hard work!” (Nick Selby, Tackling AKI Project lead, Associate Professor of Nephrology & Honorary Consultant Nephrologist)