STH ACUTE KIDNEY INJURY (AKI) PROJECT

Transcription

1 STH ACUTE KIDNEY INJURY (AKI) PROJECT Project Sponsor: Dr Andrew Gibson, Deputy Medical Director Clinical Lead: Dr Bisher Kawar, Nephrologist Nurse Educator: Louise Wild, Renal Nurse Pharmacy Lead Alison Westley Doctor Education Leads - Dr Haroon Naeem & Dr Helen Sims-Williams Renal Advanced Nurse Practitioner Yvonne Bernes Project Manager: Sarah Chown, Service Improvement

2 NCEPOD Adding Insult to Injury Report A 2009 report by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) found that o 15% of AKI cases were avoidable o It identified failures in the identification and management of AKI & o that only 50% of patients reviewed received good care. From this the Department of Health commissioned the National Institution of Clinical Excellence(NICE) to develop guidelines on the prevention, early recognition & management of AKI including timely referral to Renal Services. STH Acute Kidney Injury (AKI) Project 2

3 STH Project Aim The project was set up in response to the NCEPOD recommendations & follows the NICE Guidelines The aim of the AKI Project is to improve the prevention, recognition and management of AKI across the Trust. Page 3 of 7

4 Benefits for Specialties Improved patient flow and reduced LOS o if STH is similar to the national norms then 10-30% of the AKI would be preventable o if 10% of AKI were prevented at STH this would be equivalent to a saving of 18 beds per annum Improved coding of AKI cases o this will result in additional income, particularly for areas with high AKI cases Page 4 of 7

5 AKI Common and Serious Acute Kidney Injury (AKI) is a rapid reduction in kidney function (previous known as acute renal failure) 10-20% of hospital admissions 2-4 pts on average 20 bed ward Who are they and how can we identify early? Estimated annual no. of deaths MRSA VTE AKI STH Acute Kidney Injury (AKI) Project 5

6 How are we implementing this? An education program which aims to better equip Doctors, Nurses and Pharmacists to improve the identification & management of AKI. The first stage was to implement an AKI policy AKI care Bundle Checklist AKI NCG ICE alerts from labs highlighting possible AKIs Doctor & Nurse educational posts to provide; o Education of junior doctors at central induction o Bedside teaching and presentations for doctors o Formal & informal education for nurses on all wards AKI Patient Information Leaflet

7 Education Programme On the ward training starting in high AKI areas o Phase 1 (September 14-Feb 15) General Surgery, Orthopaedics, Care of the Elderly, Acute Medicine & MAUs o Phase 2(December 14-May 15)- Urology, Plastics, Respiratory, Gastroenterology, Diabetes & Endocrinology o Phase 3(April 15-August 15)- Specialised Cancer, Specialised Medicine, Communicable Diseases, Specialist Rehabilitation o Phase 4 (July 15-November 15)- Neurosciences, Cardiothoracic Services, Vascular Services Page 6 of 7

8 The AKI Care Bundle is for AKI Management and should be included in the notes for Patients Identified as having AKI at any stage (Available on the intranet & to order PD7621) STH Acute Kidney Injury (AKI) Project

9 NCG (No.20) helps nurses caring for patients with or at increased risk of AKI STH Acute Kidney Injury (AKI) Project 9

10 Give all Patients Identified as having an AKI an AKI Patient Information Leaflet. Empowers patients to understand what has happened to them & to be aware of the risks in the future which may prevent another occurrence of AKI (part of their past medical history, alerts staff)

11 AKI Lab Alert Warnings help with identifying patients with possible AKI cases based on creatinine results STH Acute Kidney Injury (AKI) Project 11

12 Click on the AKI Care Bundle & Nursing Care Guidelines to print them off A stock of Bundle Checklists should also be kept on the ward for AKIs identified through reduced urine output STH Acute Kidney Injury (AKI) Project 12

13 My Role, What I do? Developing seconded role that at the moment is purely educational. I have professional guidance from my line manager & am kept on target with project goals by the project team 6 weekly meetings to discuss our progress as a team

14 Empower nurses to effectively & safely manage their patients My aim is to promote the value of AKI to staff My Education Focus- o Promoting adherence & use of the NCG o The use of AKI Bundle Checklist that must be included in the notes o Fluid Balance accurate monitoring o Urinalysis & samples o Lab Alerts o Medication Review How I approach this- Engage with senior nursing staff & Clinical Educators for support of the project aims and to facilitate education. o Ward based teaching, use of existing education forums to present relevant case based session, drop in sessions. o Attend Lab Alerts o Leaving information for staff to review in their own time. o Being as flexible as possible. o Appreciating the many initiatives being rolled out & thinking how AKI prevention detection & management can tie in with everyday practice

15 Achievements & Findings What I have achievedo The incidences of AKI reporting have gone up. This should reflect the training so far by myself and the medical leads for Dr training. This is known due the work of the coding team. o Creating a growing network of contacts around the trust & nationally. o The continued support of senior nursing staff allowing & encouraging staff to attend study days. o Development of an AKI patient leaflet along with Sister Hilary Lintern Positives findingso Good response from all levels of staff, enthusiasm & value for the severity of AKI o Advertising works! - Promoting for example the UOS AKI S/D mainly via o Getting another part time AKI nurse educator, should lead to more effective coverage for education Difficulties experiencedo Staffing levels, unable to spare nurses for training. o Culture change o Winter bed crisis stopped all training in the trust, this has put things behind somewhat. o Administration time, PALMs inputting. o Being Part time o Covering 3 sites

16 Assessing numbers & Effectiveness of AKI Training PALMs- recording staff that have had training or awareness of AKI The target is to train 25% of Nursing staff (all inpatient areas) within the project time frame, PALMs should be able to help calculate this It is estimated that nearly 80% of pharmacists have had AKI awareness training Beyond the project time frame need to look at how to maintain the AKI momentum & continue best practice Coding- provides a means of auditing the incidences of AKI & use of the AKI Care Bundle. It should result in additional income, particularly for areas with high AKI cases

17 Keeping the AKI momentum Maintenanceo Champions ideally for each ward area, encourage to attend the UOS AKI S/D. o Training Trainers & champions to cascade information & training. o Quick reference poster for each ward o AKI Nurses Regional Forum, share best practice and see what other trusts are doing o present on General Surgery S/D & Cardiothoracic Mandatory Training Days & UOS AKI S/D Future Ideas & Planso AKI elearning o Possible amendments to the SHEWs charts o To investigate if an AKI trigger could be added to clerking sheets to highlight on admission o Interested in local initiatives (SAC)

18 Further Information NICE Guidelines - be familiar with NICE elearning - useful tool & background NHS England AKI Program - gramme/ Think Kidneys NHS Campaign -

19 Remember Thank you for your time STH Acute Kidney Injury (AKI) Project 19