When the acute kidney injury (AKI) programme commenced in 2013 the primary objective was to deliver and implement a structure and tools within three years that would lead to a fall in the number of preventable episodes of AKI, and with that a reduction in associated deaths.
My first reflection is over the means by which this ambition has been achieved. This has been mainly through:
- The passion and commitment of the people that we have worked with throughout the project which has been truly amazing.
- Recognition at the onset of the programme that success would be dependent on the ability to improve awareness and management of AKI across all sectors. Over the last three years we have demonstrated the ability to work across the boundaries of healthcare and provided opportunities to work with large numbers of front line staff, patients and their supporting organisations.
- The opportunity for three national organisations to work in partnership namely the UK Renal Registry, NHS England, and the national patient safety team (now based in NHS Improvement).
My involvement in the programme has been to provide patient safety leadership. I’d therefore like to also use this blog to reflect on some of the opportunities created by bringing the AKI programme under the ‘umbrella of patient safety’.
One of my first priorities for the programme was to look for incidents involving AKI and acute renal failure reported to the National Reporting and Learning System (NRLS). This search identified around 5,000 incidents reported between October 2003, when the NRLS was launched, up until the end of 2013. In the sample of incidents reviewed the majority related to themes of delayed treatment and inappropriate management or treatment, which mirrors the priorities for a number of the AKI programme’s workstreams.
Although these themes had been previously identified in data collected and published by a number of organisations, having the opportunity to read a number of the actual incidents reported to the NRLS really brought home to me the message that AKI occurs in every part of the NHS and is avoidable in so many cases. We were able to share some of these anonymised incidents in an early workshop which, together with patients sharing their own experience, really brought depth and reality to the programme being established.
Over the programme’s three years, the national patient safety team had the opportunity to provide support by issuing two national Patient Safety Alerts and a national CQUIN incentive scheme to:
- Standardise the detection of AKI through implementation of the NHS England AKI algorithm into laboratory information management systems (LIMS).
- Create a master patient index by sending data from LIMS to the UK Renal Registry.
- Improve the quality of reporting of AKI within the discharge summary.
- Raise awareness of the resources that have been produced by the programme to support the identification, prevention and treatment of AKI across all care settings.
We recognise that the impact that our work has had on individual care won’t be immediately measurable but have learnt the importance of accessible data to be able to demonstrate that improvement is taking place.
Although I know that compliance with the original AKI Patient Safety Alert ‘Standardising the detection of AKI’ was initially challenging for some organisations, the creation of the master patient index will allow us to measure improvement at both local and national level and support the identification of measurable outcomes for future safety initiatives.
To date the national patient safety team has had less involvement in primary care and social care than other sectors, so another important element of this programme has been the ability to engage successfully with these two sectors.
I think the NHS is now well positioned to continue to make demonstrable improvement in safety for patients at risk of AKI. However, future relationship with the Patient Safety Collaboratives and other national and local improvement initiatives will be important to support the sharing of best practice and introducing sustainable change.
I look forward to a continued relationship with all partners in this work and hope that you will also be encouraged and motivated to continue with any local activity that you are involved in to improve the management of patients with AKI as well looking for opportunities to share this work through engaging in wider initiatives.
Joan Russell
Joan is currently Associate Director of Patient Safety for NHS England. A nurse by background, Joan trained at Middlesex Hospital in London and went on to do her BSc at Greenwich University in 1990.
Previously Joan worked for the National Patient Safety Agency where she was Head of Patient Safety (Anaesthesia and Surgery). This role involved developing national strategy for improving patient safety in anaesthesia and surgery. Before then Joan was Head of Governance for the London Ambulance Service NHS Trust and Client Manager for Health Quality Service at the King’s Fund.
Out of work Joan enjoys walking and watching Rugby. Her favourite holiday destination is New Zealand which is perfect for both walking and Rugby!
Joan can be contacted at joanrussell@nhs.net