The attendees at the AKI event were invited into break out groups to discuss the following:
- How can you ensure AKI programme is collaborative and Trust wide?
- What are the barriers to delivery?
- Agree 3 outcome measures that could be used across the SW
- What support is required from SW SCN CV Network?
- The common themes were:
Collaboration & Trust wide approach –
- Ensure all understand ‘it is their problem’ and not just the renal team
- Have an AKI /outreach nurse (for at least 2&3)
- Good communication within and across teams
- Representation from each directorate on AKI group (IT, biochemists, all specialities)
- AKI is part of Trust quality programme/agenda
- Development of a CQUIN
- Multi-staff education
- QIP + Trust bulletins and team brief
- Buy in at board level – require data to evidence issue
| Proposed actions - Collaboration | Responsibility |
| Develop Trust wide steering groups with MDT representation | Each Trust |
| Involve outreach teams | Trust |
| Contact Trust safety & quality leads | SCN/Trust |
| Contact medical directors/Trust board regarding AKI problem and the evidence | SCN/Trust |
| Write a bulletin/brief to go out in each Trust and commissioners. | SCN |
What are the barriers to delivery –
- It systems – seeing results and accessing them
- Clinician awareness and knowing what to do with results once accessed
- Funding and resource to implement and embed change
- Achieving ‘buy in’ at Trust level and at clinician/nurse level when there are so many priorities
- Poor leadership regarding this issue alongside accountability
- Poor quality data (need NHS number and location on all patients)
- No protected education time especially for nursing staff – joint approach
- Little patient information available
- Problems with ‘drug packs’ for patients
| Proposed actions – Barriers to delivery | Responsibility |
| Share teaching programmes | SCN/Trust |
| Each Trust requires a clinical champion to lead on responses to e-alert and how the triggers work and are picked up. These should be the clinicians who attended the AKI event. | Trust |
| Ensure funding is accessible by those that need it and they have a plan through steering group what issues it will address. | Trust/SCN |
| Look at what works regarding education – e-learning, posters, mandatory sessions on Trust induction, Trust bulletins. | Trust/SCN |
| Ensure IT representation on steering group – use funding to support systems | Trust |
| Advertise March event at each Trust, CCG, primary care – patient representation. | SCN |
Outcome measures-
- Reduced morbidity/mortality associated with AKI
- Reduced LOS
- Compliance with care bundle
- Number of e-alerts V number of care bundles initiated
- Number of care bundles in place and being used – (? sticker in notes if used and completed)
- Reduced progression through AKI stages once intervention in place
- Reduction in in-patient AKI prevalence
- % risk assessed for AKI on admission
- % acquired AKI (community/hospital)
- % avoidable AKI
- Good baseline data including AKI 1, 2, 3 stages
- % reduction of patients progressing to RRT
- Support required from SWSCN-
- Patient information leaflets – risks, post AKI, contrast etc
| Proposed actions – outcome measures | Responsibility |
| Collate current data measurements that are being collected (not data just the measurements) | SCN/Trust |
| Collate baseline data measurements and share ( not data just the measurements) | SCN/Trust |
| Link with national programme and RR requirements – share this with clinical leads | SCN |
| Agree a set of outcome measurements to be used across the region – potentially involve patient safety leads in this as they may have quality/safety measurements that are required | SCN/Trust |
| Develop a CQUIN requiring a RCA at AKI stage 3 | SCN/Trust |
Support required by SWSCN –
Regional CQUIN
Dashboard
Inter-lab IT
Interactive clinical info systems
Lobbying commissioners regarding AKI (CCG now commission renal services)
Coordinating and sharing of: Guidance, care pathways, education packages
Development of patient information
| Proposed actions – SCN support | Responsibility |
| Invite CCG leads to March event | SCN |
| Put something regarding AKI in their bulletins (CCG & Trust) | SCN |
| Make more use of NHSESW web site and keep updated regarding AKI – documents, links, care bundles. | SCN |
| Email feeds keeping all contacts in the loop | SCN |
| Share contact details showing – clinical champion, what they have got in place, what data they are collecting | SCN |
| D/W national team regarding CQUIN/dashboard | SCN |
| National programme direction regarding patient information | SCN |
| Minimum standards for discharge – on summary, GP informed, patient informed & given leaflet regarding future risk, sticker on notes. | Trust/SCN |
| Raising general awareness – screen savers, badges, ties, promotional items. | SCN/Trust |
