A Novel Approach to Acute Kidney Injury Management in a District General Hospital

Our project envisages an acute kidney injury (AKI) in-reach team to detect AKI early with an intention to prevent progression of AKI and dialysis dependency. This project aims to build on the work done in 2023-24 to improve AKI management in Glangwili Hospital by an out-of-program Renal Specialist Registrar and two Consultant Nephrologists.

The aims of our project are as follows:

1. Early intervention for patients with AKI with an intention to reduce  progression to stage 3 AKI and  long term Chronic Kidney Disease (CKD).
2. Reduce the number of patients with single organ renal failure being transferred to : i) ITU for haemofiltration ii)  the tertiary renal ward at Morriston Hospital, Swansea, by dialysing patients on the satellite unit in Carmarthen.
3. Develop an AKI teaching series tailored to doctors and nurses on hospital wards. Evaluation of effectiveness of the teaching by auditing adherence to AKI core principles of management.
4. Establish a nurse-led AKI HOT clinic to review patients post-discharge, providing care closer to home.
5. Work in partnership with the Paul Popham Renal Charity to identify:
   1. AKI patients who require social support/counselling on discharge.
   2. Expert Patients interested in mentoring others with a similar diagnosis.

The service will be delivered through a multidisciplinary team approach. An AKI specialist nurse will triage patients from electronic AKI alerts and medical handovers. She will review patients on the ward until recovery of AKI. Consultant Nephrologists attending Glangwili Hospital will guide the management of AKI patients triaged by the nurse. A Physician Associate will identify AKI patients in A&E and CDU, and manage audit data. Pharmacists will educate on medication adjustments for AKI patients. A member of Paul Popham Charity will support patients post-discharge, offering community-based assistance through an AKI café.