As a nurse, I’m aware of a welcome “buzz” in the air when it comes to AKI. Its profile has significantly risen since the launch of the NICE AKI guidance in 2013, with the term AKI cropping up in patients’ notes and at shift handovers at an ever increasing rate.
AKI quality standards and a national CQUIN have emerged in the past few months. Very importantly, the National Patient Safety Alert for AKI has resulted in a mandate that NHS acute hospitals adopt software that detects and reports the stage of AKI on their pathology systems, based on serum creatinine results. This is a huge step towards making sure that every patient episode of AKI is detected, and although the reporting system is currently only operational in secondary care, it will roll out to primary care in 2016. Work has also been taking place around safe medicines optimisation to prevent AKI, with emerging “sick day rules” for temporarily stopping medications that may harm the kidneys when a patient is unwell or dehydrated. Patient information leaflets are being introduced to teach patients how to look after themselves and their kidneys following an episode of AKI.
What does all this mean for nurses and their patients? For patients, hopefully we will see a cultural change whereby healthcare professionals “Think Kidneys” during each and every patient encounter or review of a serum creatinine.
Prevention is always better than cure so we need to understand AKI risk factors. When assessing hydration status and urine output we also need to be alert to oliguria and serum creatinine trends. We need to know which medications may be harmful to our patients’ kidneys when they are unwell or dehydrated. If we see an AKI warning on the laboratory report, we need to know in our own workplace who we escalate this to.
It is clear that education is key to achieve all of the above. The Think Kidneys Education workstream is working with multi-professionals to ensure that AKI is embedded into undergraduate training, which is good news for future nurses. For those of us who are in practice now and have not been exposed to AKI education, there are opportunities to learn from the case studies on both the Think Kidneys site and the NICE AKI e-learning module.
In practice, nurses can make a difference by being mindful of risk factors, recognising the abnormal and knowing when to escalate. Next time you assess your patient, Think Kidneys and ask yourself some simple questions:
- Does my patient have AKI risk factors?
- Is my patient passing normal volumes of urine?
- Is my patient unwell or dehydrated and taking medication that may harm the kidney, including over the counter medications?
- Has the laboratory system reported an AKI?
- Do I need to escalate any of the above to a doctor?
So, my message to all nurses is to give it a go – enjoy the resources on this website, learn about AKI and always “Think Kidneys”!
Coral Hulse
Coral is a Nurse Consultant for the Critical Care Outreach Service at Mid Cheshire Hospitals NHS Foundation Trust and is an advisor to Risk workstream of the “Think Kidneys” National Programme for AKI.
Coral was a member of the guideline development group for the NICE clinical guideline 169 on Acute Kidney Injury, and following its publication continued to work with NICE to help develop the NICE AKI Quality Standards and the NICE AKI e-learning package. As well as her work with NICE, Coral has worked with the North West Advancing Quality Alliance (AQuA) to develop regional AKI Quality Standards. She is an active committee member for the Cheshire and Mersey Acute Kidney Injury Network and is Chair of the Cheshire and Mersey Critical Care Network’s Outreach Task Group.