The National Institute for Health and Care Excellence (NICE) in the UK last week flagged concerns that 12,000 lives a year could be saved in England by taking simple steps to avoid or properly identify and treat Acute Kidney Injury (AKI) in patients admitted to hospital. Thanks to proactive work by clinicians at Noble’s Hospital, the Island is described as ‘ahead of the game’ by Renal Consultant, Dr Matthew Todd.
AKI is the term for deterioration in kidney function; it can develop quickly, even in a matter of hours, and can easily go undetected – estimated to be present in one in six hospital admissions. The ‘injury’ is usually on the cellular level, rather than due to trauma to the kidneys, and can be exacerbated by things as simple as dehydration, or problems with medication and infections. Kidneys are usually the first organs to fail, and if AKI is not detected and treated, it can lead to kidney failure and the requirement for dialysis and a kidney transplant, making it an extremely dangerous condition.
The Isle of Man has seen a significant investment in kidney care over the past few years, most recently with the opening of a new satellite Renal Unit at Ramsey and District Cottage Hospital, greatly increasing the Island’s capacity to provide dialysis. A dedicated Renal Consultant for the Island, in the form of Dr Todd, was also appointed in 2012 to lead kidney care.
Dr Todd said: “Although NICE are just publishing these guidelines now, my colleagues and I have already undertaken a significant amount of work to raise the profile of Acute Kidney Injury amongst staff at Noble’s Hospital, putting appropriate protocols in place – so in that sense we’re ahead of the game, which is a real positive for patients.
“Whilst patient care is always our top priority, the costs associated with not detecting and quickly treating AKI can be staggering – estimated in 2011 to be up to £186m in the UK NHS. This is because AKI can lead to longer hospital stays and can require more complex treatments and intensive intervention. So in line with the spirit of the Island’s Health Strategy, prevention and early intervention really are the key here.”
Dr Todd has been instrumental in upping the ante for kidney care and AKI in the Isle of Man, raising awareness of the importance of prevention, early detection and treatment, primarily through staff education. Termed ‘the silent killer’, AKI is now deemed as important an issue to tackle as hospital acquired infections and deep vein thrombosis; such is its prevalence amongst inpatients.
Dr Todd continued: “A base line audit of AKI incidences and outcomes at Noble’s was carried out in October 2012, and we’ll be undertaking a review again in October this year to provide us with comparison data. Staff education is key – AKI can crop up in all specialities, so all staff need to be aware of how to prevent it from developing and how to monitor patients. Basics like hydration are a significant factor in prevention, but certain medical procedures and medications can potentially lead to kidney problems, which is why, generally, all patients have a kidney function test upon admission. It’s also one of the reasons why we monitor a patient’s urine output. We want patients to be as safe as possible and protected from instances of avoidable harm; so we have to be vigilant and proactive. We can’t rest on our laurels, we have to keep up the momentum with education, and these new guidelines from NICE will give us additional food for thought.”
With Dr Todd, Noble’s Hospital has a dedicated Renal Consultant on hand; ensuring advice is available for clinicians, which isn’t always the case in UK hospitals of a similar size to Noble’s. The message on the importance of watching for AKI has filtered down to frontline staff including Bernie Smith, Senior Health Care Assistant, who works on Ward 2 at Noble’s Hospital and has a particular interest in hydration.
Bernie said: “I’m very passionate about ensuring high standards of basic of care and safety, such as patient hydration. Making sure that patients have plenty of fluid is an extremely important part of preventing kidney damage. We saw this with July’s heat wave, where a few patients admitted during this period were found to have kidney problems as they weren’t keeping their fluid levels up. The hospital ran a two week hydration campaign in 2011 to kick-start a long term and sustained drive to improve awareness of the importance of hydration. Dehydration can cause things as common as tiredness and headaches to more series conditions such as kidney damage. It’s this later element in particular that makes us so determined to maintain focus on putting hydration at the very core of basic care for patients. All patients have water jugs by their beds, which are checked regularly and patients are encouraged to drink, with their fluid intake monitored and assistance available for those who may struggle.