A behaviour change approach to supporting the response to Acute Kidney Injury alerts

Lead: Dr Jane O’Hara / Professor Rebecca Lawton

Collaborators: Dr Sherena Nair | Dr Andrew Lewington (LTHT) | Dr Rob Jackson (LTHT)

Of increasing importance both nationally and locally for patient safety is the issue of Acute Kidney Injury (AKI). AKI is a rapid deterioration of renal function, resulting in inability to maintain fluid, electrolyte and acid-base balance. It is detected and monitored by serial serum creatinine readings primarily, which rise acutely. Inpatient mortality varies greatly, but in the UK it may be 20-30% or even higher, and patients who have had AKI are at increased risk of developing CKD. Better managing AKI is receiving increasing focus by policy makers, with the UK National Institute for Health and Care Excellence (NICE) in 2013 publishing guidance on this issue.

As part of the EBT Theme’s work on behaviour change for patient safety transformation, we are currently undertaking a small project which aims to use behaviour change approaches to the underpin better management of the response to AKI alerts. This will involve mapping the process of receiving and responding to AKI alerts, followed by identifying the key behaviour within this process to understand further and seek to provide support for. Please follow Research Capability Funding link for details of additional AKI behaviour change work.

Behaviour change to prevent Acute Kidney Injury

Lead: Dr Jane O’Hara
Collaborators: Sally Moore, Research Nurse, Bradford Institute for Health Research; CLAHRC evidence based transformation theme
Acute Kidney Injury (AKI) is emerging as a global patient safety issue.  Estimates suggest that one in five emergency admissions into hospital are associated with AKI (Wang et al, 2012), with approximately 100,000 deaths in secondary care associated with acute kidney injury, many of which may be preventable. Over the past 9 months we have begun the development of an intervention using an approach previously found to be successful in implementing patient safety alerts (Taylor et al., 2013;2014) We have i) mapped the current process for identifying and managing AKI within LTHT; and, ii) identified the target behaviour. We have done this in combination with key stakeholders from across the trust, and have identified members for the implementation team to take this work forward.

This current project will facilitate the next key stage in this work, the identification of the barriers to, and levers for, the identified target behaviour(s). This will be undertaken using an adapted version of the Influences on Patient Safety Behaviours Questionnaire (Taylor et al, 2013).  A purposive sample of representative staff from across LTHT will be asked to complete the survey. From this the barriers and facilitators for the target behaviours will be identified and we will use this and a consensus process to develop our intervention. It is then our intention to apply for funding to evaluate an intervention to support the management of AKI, based on the data generated from this study.