Patient safety: taking the piss. Literally!

A brilliant day at Pontio on Friday (https://www.bangor.ac.uk/about/pontio/pontio-innovation.php.en): rather quiet with most of the students currently on holiday and space to work, think, reflect. And meeting up with David Hunnisett from Elidir Health (https://www.elidirhealth.co.uk/) who takes me around the innovation lab. This is the place where Ben Ryan started the work to print his son an artificial arm in what might well have been a world first (http://www.bbc.co.uk/news/uk-wales-39106937).

In the middle of it a 10 by 10 meter white cube allowing 3D projections.

But innovation does not stop there: it continues into the toilets. Waterless pissoirs saving water and energy and next to health education: ‘Are you hydrated? Take the Urine Colour Test!’ The darker the urine the more dehydrated. As the colour turns to brown a serious health warning – time to see the doctor. A simple idea that allows staff and students to get actively involved in their health care. And bafflingly similar to a project that we ran with the HealthFoundation to improve safety of patients at risk of Acute Kidney Injury.

Acute Kidney Injury (or short ‘AKI’) is an acute decline in the functioning of the kidneys. It is a common complication of acute illness of any kind. Severe infection, low blood pressure, poor heart function, dehydration, gastro-enteritis, accidents and broken bones … anything that lowers the blood flow through the kidneys can turn down the amount of toxins that get cleared. And medication can make this complication worse: blood pressure lowering drugs, water tablets, non-steroidal anti-inflammatory painkillers like Ibuprofen and Diclofenac and some antibiotics can cause further problems. As you would expect: elderly patients often have several conditions that predispose to Acute Kidney Injury and are much more vulnerable.

Acute Kidney Injury comes with a hefty price tag of human suffering and cost: a quarter of patients who develop the condition will die in hospital, either of the disease that triggered AKI or due to blood poisoning from kidney failure. And those who recover often take a long time to get back to their normal health.

It appears that at least some of the cases of Acute Kidney Injury that occur in and out-side hospital are preventable. If patients at risk take in enough fluid and stop the medications that can make things worse while they are unwell then the risk to suffer catastrophic deterioration decreases.

Enter the Helen Hamlyn Centre for Design (https://www.rca.ac.uk/research-innovation/helen-hamlyn-centre/about/) at the Royal College of Art focuses on Design to improve peoples lives in health and disease. Together with clinicians from Wales and London we designed a set of simple interventions that allow patients to protect themselves from some of the risks of Acute Kidney Injury.  With AKI – PRO (http://www.1000livesplus.wales.nhs.uk/rrails) we are currently rolling out these interventions across Wales: If the central laboratory computer sounds the alert about declining renal function members of Rapid Response Teams and Renal Specialists go out to speak to doctor, nurses and the patients themselves. Potentially risky medications get stopped and patients get a KidneySafe Bracelet that has a similar array of colours to the ones seen in the poster at Pontio. Patients wearing the bracelet had three times more urine output (and better recording) then those who didn’t.

Simple things do therefore seem to have encouraging effects. If we could train for the main risks that occur in hospital while people are well, at work or out and about, then responses during illness might get more reliable.

Which other conditions that complicate hospital stay could be amenable to training & education?

 

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