Managing acute kidney injury

[Anonymous]

What are your main concerns about acute kidney injury and the way it’s managed in your organisation?

Do you have ideas about how its management could be improved?

Do you know where care is better organised? What would be the best way to learn from others about best practice?

Tell us what you think

richardfluck

I am keen to understand where in your organisation the principle problems and barriers reside.

suzyann

Hi I am an AKI Specialist Nurse (new to the role and a new role within my organisation) and I have found a lot of improvement is needed, in which I suppose is my role. The basic principles of the management of AKI are sometimes not adhered to i.e urine dip, fluid balances!!! MSU/CSU, repeating bloods are just some of the things.

The way I am attempting to tackle this is through teaching and education of ALL levels of staff, a new design in care bundle and I am launching a campaign to raise awareness of AKI, I attend the AKI working group in my area and I have a Twitter account for the staff for updates (attempting to stay up-to-date with the world :)).

I also think that this forum is a fantastic idea and how good it is to establish networking throughout the country as I did feel quite alone at first.

Duncan Whitehead

There are several barriers to achieving a consistent standard in the management of AKI in any organisiation. Every clinician has their own approach to patient care. I have tried to give a framework with a trust guideline for AKI to work with, consultants (including mmyself) rarely refer to or use other peoples guidelines I have noted!

I have attempted through several different meetings (grand rounds/ medical audit meetings for example) to spread the word and highlight the association with AKI and increased LOS and mortality. There is some cultural inertia regarding AKI care and recognition. A clear and rationale view recently expressed by a senior colleague is that the right treatment for the patient must be holistic and balanced based on the patients PMH, frailty, and so care bundles and protocols are frequently not appropriate for the patient with AKI, who is often elderly with multiple co-morbidities which are contributing to their current symptoms and physical state.

I suspect small steps improving uncontroversial elements of care such as 100% urine dipstick analysis on arrival will slowly develop and result in an overall better standard of care, allowing clinicians some freedom to practice medicine in their preferred manner! Any suggestions welcome.

richardfluck

Thank you for your comments.

The core aspect seems to be about awareness/education and guidance. Duncan, your point in the last paragraph is well made. We do need to provide the framework but allow for clinical interpretation.

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