Staff at University Hospitals of Morecambe Bay NHS Foundation Trust have been working on changes to help staff spot potential life threatening Acute Kidney Injury (AKI) early on the Medical Admissions Unit at Furness General Hospital (FGH). They are one of the first eleven Listening into Action (LiA) Pioneering Teams.
AKI is a sudden deterioration in kidney function over hours to days resulting in the inability of the kidneys to perform the functions of producing adequate urine, excreting wastes, toxins and acids and eliminating excess fluids and salts. The commonest causes of AKI are dehydration and sepsis.
Speciality doctor, Dr Begho Obale is leading these changes and working with multi-disciplinary teams made up of nurses, health care support workers, doctors, pharmacists, student nurses and medical students. The aim is to raise awareness that AKI is treatable if identified early, and to provide information on the causes, patients at risk, and the importance of good fluid balance in the management of AKI.
So far Dr Obale has trained 200 members of staff across the Trust on the causes of AKI and how to identify patients at risk, as well as other important factors including:
- Urinalysis: how the presence of blood and protein on dipstick testing can identify 'at risk' patients
- How to measure and interpret urine output
- The importance of stopping Nephrotoxic drugs which have a tendency to cause damage to the kidneys, especially in patients who are dehydrated or have low blood pressure due to bleeding or sepsis. Examples of these drugs are Ibuprofen and Ramipril.
The team have introduced a chart to record patients’ weight and minimum expected urine output per hour so that clinical staff can monitor patients more closely. They have also provided patients with information so that they are aware of importance of urine collection to their overall recovery.
Dr Obale said: “One in five people admitted into hospital have AKI and it is associated with over 100,000 deaths in hospitals across the country each year. Early identification of patients at risk of AKI and accurate fluid balance management is the key to treating patients with AKI more effectively. Awareness of AKI and good management of the condition really does save lives. Multidisciplinary input from all levels of ward staff – from Healthcare Support Workers to Consultants – is vital in achieving good outcomes for our patients, which is why we have involved them all in this work.”
So far results have been very positive. A recent audit at the Medical Admissions Unit at FGH demonstrated significant improvements in the management of fluid balance monitoring charts which scored 100% at this audit, compared to 65% achieved at the Trust-wide AKI audit that took place in July 2014.
Patients at risk of AKI include the elderly, patients with chronic diseases such as chronic kidney disease, heart failure, liver disease, Diabetes, urinary obstruction, the use of nephrotoxic drugs, and those with a reduced urine output.
The AKI work is one of 11 of the Trust’s Listening into Action (LiA) Pioneering Schemes. The Trust launched Listening into Action (LiA) in September last year to put the decision making power back in the hands of its staff.
Sue Smith, Executive Chief Nurse, said: “I’m delighted with the progress Dr Obale and the team have made so far and to hear that 200 staff within the Trust have already received training on AKI. This work is one of the Listening into Action (LiA) Pioneering Schemes – these are patient-focused teams where the work takes 20 weeks to complete and I am honoured to be the executive sponsor for this exciting work. I’d like to thank Dr Obale and the team for all their hard work to date and for the contribution they are making in helping the Trust deliver excellent patient care".
Listening into Action (LiA) complements other important work taking place at the Trust, including the CQC Improvement Plan and Better Care Together. Dr Obale and her team will showcase their work at a ‘Pass it On’ event for Trust staff on 22 June 2015.