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Managing Acute Kidney Injury: Lessons Learned from a Patient Case Study

This case study discusses a 74-year-old man who was admitted to the hospital with a 48-hour history of diarrhea and vomiting following the consumption of reheated chicken, impacting his existing health conditions like hypertension and COPD. Despite improvement after IV fluids, he experienced a peri-arrest situation, leading to cardiac arrest. The case emphasizes the importance of timely interventions and reviews of care processes to improve outcomes in similar scenarios. It also highlights the need to enhance responses to AKI alerts and integrate learnings from collaborative patient safety initiatives.

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Managing Acute Kidney Injury: Lessons Learned from a Patient Case Study

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Presentation Transcript

  1. Next Steps ‘Getting the Basics Right’ #AKISummit

  2. Patient Story • 74 old man • Admitted on 14/8/2017 • 48 hour history of D and V • Onset day after re-heated chicken in microwave – gave half to pet dog – also unwell • PMH – hypertension / COPD / type 2 diabetes / COPD / falls • Lives alone. Ex-smoker. No PoC, family nearby • Daughter helps with shopping and housework #AKISummit

  3. Drug History Amitriptyline 25mgs Nocte Amlodipine 10mgs OD Atorvastatin 20mgs Nocte Clopidogrel 75mgs OD Co-codamol 30/500 2 QDS Perindopril 8mgs OD AnoraEllipta 1 puff OD Salbutamol PRN #AKISummit

  4. Examination and Results NEWS on arrival: HR 132 (improved with IV Fluid) BP 99/52 R/R 20 BM 9.8 Sats 95% on air Alert Temp 36.2 Abdo soft, but tender throughout deep palpation NEWS 6, improved to 4 after IV fluid Cannulated 20 05 – IV fluids commenced. Decision – not for sepsis 6 as probable viral gastro-enteritis NEWS improved to 3 after IV fluid #AKISummit 20 10 - 14/8/17 Hb 17.6 WCC 42 Platelets 386 Na 133 K Haem Chl 97 Bicarb 11 Urea 11.8 Creat 135 eGFR 46 Lactate 2.9 AKI alert phoned to ED

  5. Repeat bloods 15/8/17 – 1AM Na 140 K haem Chloride 101 Bicarb 8 Urea 16 Creat 183 E GFR 32 AKI phoned to ward #AKISummit

  6. On Review SHO R/V 2 45 am Patient peri-arrest – attempting to obtain blood, cardiac arrest – unsuccessful resus attempt #AKISummit Venous gas during arrest: PO2 1.7 Co2 2.4 Bicarb 8 H+ 85 Na 148 K+ 1.5

  7. Learning System? #AKISummit “Hi Calum The commissioners are happy for this to be downgraded to a category 2 as the outcome for the patient was inevitable. They are happy that you have reviewed the casenotes and there were no medical or nursing issues found. I was told the feeling was that there was no problem with the care and treatment the patent received i.e. an adverse event didn’t occur. ” • “Nobody said that an adverse event didn’t occur. • The Datix was submitted and verified as a Category 1 • When a more detailed SBAR was made available, as commissioners ###*** and I agreed that an SAER was not appropriate • The site also reviewed the categorisation and regarded it as a Category 2 which can still generate a review out with the rigid structure of an SAER”

  8. #AKISummit

  9. Opportunities to Improve • Pre- Hospital • Response to AKI alert • Link to deteriorating Patients #AKISummit

  10. If that happened now? #AKISummit

  11. FUTURE OF AKI IN SPSP NEXT STEPS- AKI #AKISummit

  12. Harm from AKIIncidence of AKIProgression of AKI REDUCE #AKISummit

  13. Links with Deteriorating Patient – Joining the dots….. #AKISummit

  14. Aims of the day • Celebrate the achievements made in the Acute Kidney Injury collaborative • Share the learning from the collaborative teams with colleagues across NHS Scotland • Consider the next steps for Acute Kidney Injury and deteriorating patients in the Scottish Patient Safety Programme (SPSP) #AKISummit

  15. Have a safe journey home #AKISummit

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