{"id":8395,"date":"2020-09-25T12:32:16","date_gmt":"2020-09-25T11:32:16","guid":{"rendered":"https:\/\/www.thinkkidneys.nhs.uk\/kquip\/?page_id=8395"},"modified":"2020-11-17T15:05:02","modified_gmt":"2020-11-17T15:05:02","slug":"covid-london-aki","status":"publish","type":"page","link":"https:\/\/www.thinkkidneys.nhs.uk\/kquip\/covid-london-aki\/","title":{"rendered":"Renal teams supporting AKI in the critically ill patient"},"content":{"rendered":"\n<div class=\"wp-block-image\"><figure class=\"alignright size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"336\" height=\"120\" src=\"https:\/\/www.thinkkidneys.nhs.uk\/kquip\/wp-content\/uploads\/sites\/5\/2020\/09\/South-London-Renal-Clinical-Alliance.png\" alt=\"\" class=\"wp-image-8368\"\/><\/figure><\/div>\n\n\n\n<h2 class=\"wp-block-heading\">Review of London kidney teams\u2019 response to COVID-19, March-June 2020<\/h2>\n\n\n\n<h2 class=\"wp-block-heading\">Summary of key themes<\/h2>\n\n\n\n<div class=\"wp-block-group has-very-light-gray-background-color has-background\"><div class=\"wp-block-group__inner-container is-layout-flow wp-block-group-is-layout-flow\">\n<ol class=\"wp-block-list\"><li>Training of ITU teams \u2013 develop shared resources and experience across London in the training and education of renal and intensive care teams to support renal replacement therapy for critically ill patients. <\/li><li>Consider having a named renal consultant present in ITU for peak surge periods to improve communications and support teamwork and shared learning.<\/li><li>Continue to share the diverse approaches across London to help meet the needs of patients with specific RRT requirements (such as PD where coagulopathy renders vascular access very difficult). <\/li><li>We achieved good outcomes in some kidney patients using innovative solutions.&nbsp; How do we evaluate these for use in the future? <\/li><li>Intermittent haemodialysis was an option for ongoing HD care in place of CRRT. <\/li><li>Kidney teams can collaborate with critical care teams to minimise risk of acute kidney injury and avoid starting renal replacement therapy sooner than is necessary or beneficial.<\/li><\/ol>\n<\/div><\/div>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Next steps <\/strong><\/h3>\n\n\n\n<ul class=\"wp-block-list\"><li>Use the London Networks to develop a pan-London\nITU\/Renal nurse group to support a sustainable training model to maintain\nskills. Potential to involve industry in the delivery of this.<\/li><li>Share learning between ITU and renal networks\nand ensure closer collaboration and joint planning for second surges<\/li><li>Collate outcome (PD, CRRT, IHD in AKI) and\nhistopathology data, and share analysis and findings to inform future planning <\/li><\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Summary of discussions<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>What worked well?<\/strong><\/h3>\n\n\n\n<ul class=\"wp-block-list\"><li>Collaboration between Nephrologists and\nIntensivists was vital to meet the unpredicted demand for RRT on ICU<\/li><li>Different units found different solutions (e.g.\nIHD, APD, making fluids for CVVHD) all of which had merit and drawbacks<\/li><li>The practical expertise of the technicians was\nvital in planning and delivering and expanding RRT at pace in ICU. The use of\nportable RO units was an essential part of this<\/li><li>Sector level critical care and renal\ncollaborations were vital for active movement of patients and provision of care<\/li><li>Pan London collection of data and sharing of\nwider information was also essential, not least to allow the movement of\npatients between sectors when needed<\/li><li>Local efforts by renal teams to establish\nalternatives to filtration within their own trusts were essential<\/li><li>Accelerated training nursing plans in working\nwith ITU colleagues enabled teams to deliver IHD<\/li><li>ITU teams found that having a named renal\nconsultant shared learning and improved communication and teamwork <\/li><li>There was fantastic work from Renal technicians\nto get necessary work done to facilitate RRT expansion<\/li><\/ul>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Key challenges<\/strong><\/h3>\n\n\n\n<ul class=\"wp-block-list\"><li>Working at such a pace for a sustained period\nwas challenging<\/li><li>There were different levels of network\nfunctioning and functional groups depending on purpose: clarity on each of\nthese roles only emerged after some weeks and with some avoidable duplication\nof effort<\/li><li>Managing the practicalities of installing water,\nrapidly expanding PD, sustaining workforce, and providing training<\/li><li>Burden on staff, especially dialysis nurses, to\nprovide renal support in ITU whilst also maintaining staffing for ICHD units<\/li><\/ul>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>What could we do better?<\/strong><\/h3>\n\n\n\n<ul class=\"wp-block-list\"><li>Improve decision-making and communication with\npatients and families regarding treatment escalation plans<\/li><li>Capitalise on the opportunity to continue the\nimproved management of AKI through structured and ongoing closer collaboration\nbetween renal and ITU teams<\/li><li>Clearer transfer protocols covering escalation\nof patients in non-renal centres <\/li><\/ul>\n\n\n\n<hr class=\"wp-block-separator\"\/>\n\n\n\n<h2 class=\"has-text-align-center wp-block-heading\"><a href=\"https:\/\/www.thinkkidneys.nhs.uk\/kquip\/hub\/review-of-london-kidney-teams-response-to-covid-19-march-june-2020\/\">RETURN TO LONDON KIDNEY TEAMS\u2019 RESPONSE TO COVID-19<\/a><\/h2>\n\n\n\n<hr class=\"wp-block-separator\"\/>\n\n\n\n<h2 class=\"has-text-align-center wp-block-heading\"><a href=\"https:\/\/www.thinkkidneys.nhs.uk\/kquip\/hub\/kidney-quality-improvement-post-covid-19\/shared-learning-covid-19\/\">RETURN TO SHARED LEARNING FROM THE KIDNEY COMMUNITY <br>DURING COVID-19<\/a><\/h2>\n","protected":false},"excerpt":{"rendered":"<p>Review of London kidney teams\u2019 response to COVID-19, March-June 2020 Summary of key themes Training of ITU teams \u2013 develop shared resources and experience across London in the training and education of renal and intensive care teams to support renal replacement therapy for critically ill patients. Consider having a named renal consultant present in ITU for peak surge periods to improve communications and support teamwork and&#8230;<\/p>\n","protected":false},"author":130,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"jetpack_post_was_ever_published":false,"footnotes":""},"class_list":["post-8395","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.5 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Renal teams supporting AKI in the critically ill patient - The Kidney Quality Improvement Partnership<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.thinkkidneys.nhs.uk\/kquip\/covid-london-aki\/\" \/>\n<meta property=\"og:locale\" content=\"en_GB\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Renal teams supporting AKI in the critically ill patient - The Kidney Quality Improvement Partnership\" \/>\n<meta property=\"og:description\" content=\"Review of London kidney teams\u2019 response to COVID-19, March-June 2020 Summary of key themes Training of ITU teams \u2013 develop shared resources and experience across London in the training and education of renal and intensive care teams to support renal replacement therapy for critically ill patients. 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