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The Uclpartners Acute Kidney Injury (AKI) and Sepsis Patient Safety Collaboratives

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The Uclpartners Acute Kidney Injury (AKI) and Sepsis Patient Safety Collaboratives The UCLPartners acute kidney injury (AKI) and sepsis patient safety collaboratives Acknowledgements The UCLPartners team would like to thank the following organisations, and their participating team members, for their commitment to improving patient safety throughout this programme: Trusts • Barking, Havering and Redbridge University Hospitals NHS Trust • Barts Health NHS Trust • Basildon and Thurrock University Hospitals NHS Foundation Trust • Homerton University Hospital NHS Foundation Trust • Luton and Dunstable University Hospital NHS Foundation Trust • Mid Essex Hospital Services NHS Trust • North Middlesex Hospital NHS Trust • Princess Alexandra Hospital NHS Trust • Royal Free London NHS Foundation Trust • Southend University Hospital NHS Foundation Trust • University College London Hospitals NHS Foundation Trust • West Hertfordshire Hospitals NHS Trust • Whittington Health NHS Trust Clinical leads • Acute kidney injury: Dr Chris Laing, Nephrology Consultant, Royal Free London NHS Foundation Trust • Sepsis: John Welch, Intensive Care Nurse Consultant, University College London Hospitals NHS Foundation Trust 1 Table of Contents Acknowledgements ........................................................................................................................................ 1 Trusts .......................................................................................................................................................... 1 Clinical leads ............................................................................................................................................... 1 Executive summary ........................................................................................................................................ 4 Patient safety collaboratives ...................................................................................................................... 4 Improving outcomes ................................................................................................................................... 4 Sustaining improvements ........................................................................................................................... 5 Introduction.................................................................................................................................................... 6 Project background..................................................................................................................................... 6 AKI and sepsis ............................................................................................................................................. 6 The collaboratives ....................................................................................................................................... 7 AKI ............................................................................................................................................................... 7 Sepsis .......................................................................................................................................................... 7 Methodology .............................................................................................................................................. 8 Learning together ....................................................................................................................................... 8 Data collection ............................................................................................................................................ 9 Supporting the collaboratives .................................................................................................................... 9 Patient involvement and engagement ....................................................................................................... 9 Evaluation ................................................................................................................................................. 10 Results .......................................................................................................................................................... 10 The AKI collaborative ................................................................................................................................ 10 AKI mortality ............................................................................................................................................. 11 Renal function recovery............................................................................................................................ 11 Hospital length of stay .............................................................................................................................. 12 AKI challenges ........................................................................................................................................... 13 The sepsis collaborative............................................................................................................................ 14 Sepsis mortality ........................................................................................................................................ 14 Hospital length of stay .............................................................................................................................. 15 ICU transfers ............................................................................................................................................. 15 Sepsis challenges ...................................................................................................................................... 16 Programme learnings ................................................................................................................................... 17 Engaging in collaboratives ........................................................................................................................ 17 2 Data collection and measurement ........................................................................................................... 18 Impact on quality improvement capability and culture ........................................................................... 19 Conclusion .................................................................................................................................................... 19 References .................................................................................................................................................... 21 Appendix I ..................................................................................................................................................... 23 AKI – process measures ............................................................................................................................ 23 Recognition of AKI within four hours ....................................................................................................... 23 Percentage of treatments given on time ................................................................................................. 23 Other process measures ........................................................................................................................... 24 Appendix II .................................................................................................................................................... 25 Sepsis – process measures ....................................................................................................................... 25 Vital signs recorded within 15 minutes of presentation .......................................................................... 25 The word ‘sepsis’ recorded in patient record within one hour of presentation ...................................... 25 Intravenous antibiotics (IV AB) documented within one hour of presentation ...................................... 26 Blood culture documented within one hour of presentation. ................................................................. 27 500ml IV fluids within one hour of presentation ..................................................................................... 27 Sepsis review within three hours of presentation ................................................................................... 28 Documented evidence of escalation if not improved within three hours of presentation ..................... 28 Antimicrobial review within 48 hours of presentation ............................................................................ 28 3 Executive summary UCLPartners is an academic health science partnership involving over 40 higher education and NHS trust members serving the population of north east and north central London and parts of three connecting home counties. We bring together organisations to address big challenges in health and wellbeing in the NHS and social care. Under this remit, we worked with 13 hospital partners to improve patient care for two conditions that cause high numbers of avoidable deaths in our region and across the country: acute kidney disease (AKI) and sepsis In 2014, UCLPartners brought together senior clinicians and hospital leaders from its NHS trust partners to identify clinical areas for a quality improvement programme in patient care and safety. Causing
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