Blog 3: AQ Detection and Response – a combined focus on AKI, pneumonia and sepsis

In our third and final blog of the series, we’ll look back on our afternoon sepsis session, which focused on making small changes to see big results and the final AKI session of the day which focused on the importance of fluids in managing AKI.

Small changes, big results

In our afternoon sepsis session, Liz Kanwar spoke about knowledge and behaviours in sepsis management. Her group discussed the sepsis pathway and where delays might occur, posing questions centred on staff behaviour. Which behaviours get in the way? Why do these behaviours exist? What are the behaviours that would reduce the risk of delay? What does your organisation need to do to promote these positive behaviours? This ‘human factors’ approach broadens the improvement focus beyond systems of care to individuals within that system. On a similar theme, Dr Santok h Singh, a Consultant at Countess of Chester Hospital discussed the trust’s education programme in relation to sepsis management. Santokh described the situation when he was ‘volunteered’ for the role of sepsis lead in 2014: no time allocation, no sepsis nurses and no administrative support. Through initiatives such as the Sepsis 60 Day Challenge, sepsis-themed screen savers, mandatory training and the development of a standardised approach, the profile of sepsis at Countess has been raised and they now have a much more robust and coherent strategy for prevention and treatment. Early indications are very good, with in-hospital mortality trending downwards and the trust’s AQ Composite Process Score (CPS) trending upwards. Both Liz’s and Santokh’s presentations showed the importance of knowledge and education as well as equipment and systems. Small changes in behaviour can bring big results. This was also shown by Martin Ashley, a Consultant at the University Dental Hospital of Manchester, who presented about the importance of mouth care. It’s fair to say a number of delegates were shocked by the evidence Martin put forward that demonstrated just how bad things can get in hospital, with patients not cleaning their teeth, even if they had a healthy daily cleaning regime before admission. This might be because they aren’t encouraged or helped to do so or simply because they don’t have a toothbrush. As well as the more obvious implications this has for personal well-being and self-esteem, accumulated bacteria can be a breeding ground for serious infection, including HAP.

Charting improvement

Our final AKI session of the day focused on the importance of fluids. Anita Watson, Lead Nurse in Infection Prevention and Control for Lancashire County Council spoke about the background for their work: increasing numbers of gram negative blood stream infections and increasing resistance to antibiotics and the importance of managing this. Of particular relevance to AKI are urinary tract infections (UTIs). Using a QI approach, LCC are aiming to reduce the instance of UTIs in care homes by promoting the use of fluid balance charts to ensure residents are properly hydrated. They are doing this through training and posters and are using SPC charts to measure change. They are seeing some positive results, with an increase in the use of fluid balance charts and longer intervals between reported UTI occurrences. Jo Higgins rounded off the day for AKI by talking further about fluid balance, highlighting two north-west improvement initiatives. University Hospitals of Morecambe Bay NHS Foundation Trust used staff survey feedback to review and revise their fluid balance chart and appointed ‘hydration champions’. This saw an improvement in the use of fluid balance charts and better patient hydration across the trust’s three sites. Manchester Foundation Trust also revised their fluid balance documentation and encouraged patient participation through publicity. They developed a new fluid balance pathway and saw improvement.

Enthused and energised

Reflecting at the end of a packed day, the AQ team’s collective feeling was that the event had been a success. Bringing together three events into one was ambitious and hard work, but the combined, multi-condition focus brought something new and valuable. We ran twenty-two sessions with eighteen speakers and hosted nearly a hundred delegates. Our Twitter hashtag, #AQDetect, generated one-hundred and fifteen tweets. We hope delegates went away feeling as we did: enthused, energised and ready to put new ideas into practice. Thanks to all speakers and delegates.