Acute Kidney Injury: It’s as easy as ABCDE

Dr Jennifer McCaughan

Outline

• SQE setting

• Acute Kidney Injury

• Changing culture

• Lessons learned

The SQE Programme

• Aims

- to improve quality and safety of care

- to enhance the patient experience

- to develop skills in quality improvement

• 3 components

SQE Project

• Multi-disciplinary team

• Identify the problem

- significant in terms of quality/safety burden

- evidence-based intervention

- infrastructure to help drive change

SQE project

• Identify the aim

Acute Kidney Injury

AKI – The International Experience

19x

Increasing risk

of death

6.5x

Degree of AKI

J Am Soc Nephrol. 2005;16(11):3365-70.

AKI - The SEHSCT Experience

• 16% of acute adult admissions in UHD• Average LoS for AKI: 10.5 days • 100 day mortality: 20%

AKI - Safety & Quality in SEHSCT

• 31% of AKI recognised within 48h

• Basic steps to ameliorate AKI implemented in 20%

Aims

• To improve AKI recognition to 80%

• To design a checklist for AKI management

• To achieve 80% of checklist steps for 50% of patients with AKI

AKI - ABCDE

Pilot

• 19 bed surgical ward

Pilot• Formal teaching for MDT• Informal teaching for MDT• Reinforcement and revision of principles

AKI - ABCDE

Outcomes

Expanding the AKI Initiative

• Surgical Directorate (September 2012)

• Acute Medicine (December 2012)

• Medical Directorate (May 2013)

• By week 4, action >80% in every area

Expanding the AKI Initiative

Lessons Learned

• Implementing change requires investment

- of time

- in people

• Implementing change requires humility

• Implementing change requires persistence

Marginal Gains

‘It is better to take many small steps in the right direction than to make a great leap forward only to stumble backward’

Old Chinese Proverb

Acknowledgements

• SQE team in SEHSCT

• Members of AKI SQE group

• Renal Unit staff, Ulster Hospital

• SEHSCT Audit Department

• Dr Niall Leonard