At NIHR CLAHRC GM, we’re proud to have worked with a number of teams and organisations nominated for a Patient Safety Award this year. This blog, from CLAHRC GM Facilitator, Zoe Ashton, focuses on the important work and great achievements of one of those nominees…
Acute Kidney Injury (AKI) has gained increased awareness over recent years, with a report by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD), published in 2009, highlighting the scale of the problem; and a patient safety alert issued in 2014 by NHS England on standardising the early identification of AKI, calling for action to be taken.
A team from Salford Royal NHS Foundation Trust (SRFT) has been shortlisted for this years’ Patient Safety Awards, under the nomination, ‘The Acute Kidney Injury (AKI) Working Group: A collaborative approach to improvement at Salford Royal Foundation Trust’.
NIHR CLAHRC Greater Manchester is evaluating this AKI improvement work as part of the MAKIT project, including qualitative interviews with the AKI Working Group, wider Trust staff involved in the project and patients who have had an AKI, and have also been assisting with project management and delivery of quality improvement activities.
A collaborative improvement programme has been running at SRFT since 2015 with teams across the organisation engaged in reducing AKI. A multidisciplinary working group has led the work including system-wide changes such as implementing an AKI flag into the electronic patient record, developing an e-learning module and holding education events. Critically, this was combined with local activities where staff from across a range of roles have used a ‘Plan-Do-Study-Act’ (PDSA) cycle to test changes in their areas. Those changes have focussed on detection, intervention and prevention of AKI.
The teams have achieved impressive results:
- 23% reduction in patients developing an AKI whilst in hospital on collaborative wards and 20% reduction Trust-wide.
- 39% reduction in the number of patients progressing from an early stage 1 AKI to a more severe stage 2 or 3 AKI for collaborative wards.
- The learning from the collaborative wards has been collected into a change package and work is underway to spread this across the whole hospital.
While in other trusts, specialist AKI nurses have been employed with great success to ensure patients with AKI receive appropriate care, the SRFT ethos is that good care is everyone’s business, and changing the system together rather than relying on particular individuals, is a sustainable approach. Continuous Improvement is one of the Trust’s four Key Values, and many staff had previous experience of Quality Improvement work at Salford before being involved in the AKI programme.
Some of the important aspects of the work that the team highlighted in their presentation to the PDSA judging panel have included:
- An AKI working group with representation from key corporate functions, clinical divisions and specialist areas: A ‘doing’ group
- Medical Director as sponsor with regular updates to the Executive Committee
- AKI link nurse for each ward
- A group of junior doctors, supporting AKI improvements in their areas
- Pharmacy champions
- 10 wards actively engaged in testing changes
The working group has included individuals from the Quality Improvement department, Renal and Acute Consultants; Junior Doctors; Nursing leads; Pharmacy and Biochemistry Leads; Learning and Development staff, including practice educators; Information Management and Technology staff and data analysts; NIHR CLAHRC GM staff; a GP Electronic Patient Records (EPR) staff.
This approach has enabled the working group to ensure that there is AKI engagement and champions throughout the hospital and that learning from different areas is shared. The working group has also been linking to work going on in the community, and incorporating AKI into the discharge summary.