NHS Lanarkshire

1. NHS Lanarkshire Tuesday 23 April 2019

2. What is your biggest achievement in the collaborative? • AKI eAlerts technology supporting timely response • Building increased staff knowledge and response to AKI • Coordinated approach to AKI across Lanarkshire • University Hospital Monklands ED • University Hospital Wishaw Orthopaedics • University Hospital HairmyresOrthopaedics

3. What was key to your success? • Understanding the system

4. What was key to your success? • Bringing people together, sharing similar struggles and celebrating success has been really helpful in building a support network and getting buy in from staff to be involved • AKI lanyards very useful in generating interest and sharing base line knowledge • AKI HIS events are an opportunity to share learning from Lanarkshire, learn from others and reflect on progress to date • Commitment and dedication of the staff across Lanarkshire

5. What challenges have you overcome? • Scale of the problem and multiple factors involved • Prevention of AKI vs Management of AKI • Lack of knowledge and response to AKI • Variation in process is high • Competing demands on staff time • Dedicated support from Improvement Team

6. What is next for AKI in your board? • Meeting in May to reflect on progress to date and plan next steps • Prevention of AKI vs Management of AKI

7. Reducing AKI `s and preventing harm in patients undergoing Elective Hip and Knee Replacements Senior Mags Penman Charge Nurse Ward 14 University Hospital Wishaw

8. The Observation Following the introduction of ERAS the protocol was not to give IV fluids, no Oxygen and same day mobilisation post op. It was observed that there was an increase in patients developing AKIs post operation Patients returned from theatre with low BP and many suffered vaso-vagal episodes when attempting to mobilise. The Hypotheses was developed that the lack of fluids contributed to the increased incidence of AKIs and the other symptoms described above

9. The PDSA The Plan ~ was to determine if giving IV fluids immediately post op would reduce the number of patients developing post op AKI`s, reduce Vaso Vagal episodes and improve patient wellbeing. The Do ~ was SCN discussed the plan with the multidisciplinary team and gained agreement. The Study ~ was to review 100 patients pre overnight IV fluids and 100 post overnight IV fluids. The Act ~ was to review the 100 patients at the end of the study and draw conclusions

10. Further Work Require a consultant agreed Proforma to give elective patients undergoing total hip and knee replacements 1 litre of fluid overnight Continue the study to verify maintained improvement by looking at a further 100 patients pre and post op IV fluids

11. RESULTS

12. RESULTS

13. CHALLENGES Ensuring everyone that needed to be involved were involved Getting Consultants to agree to give their post op Elective patients a litre of fluids overnight. Although we felt we might have some challenges to overcome,it was the very opposite, everyone involved were very supportive and interested in this trial and have agreed to continue with overnight fluids for their post op Elective Patients.

14. The Benefits Reduction in AKIs Patients have a better experience (they feel better) Patients mobilise quicker The number of patients having vaso-vagals have significantly reduced Reduction in Length of stay