The Acute Kidney Injury NECPOD report “Adding Insult to Injury” surfaced a major problem in the prompt recognition of ALI risk and its management in the acutely unwell. In response the Academy of Medical Royal Colleges, Royal Collage of Nursing and National Outreach Forum have published a competency framework produced by a multi-disciplinary working group, with representation from the UK Renal Association, the Society for Acute Medicine, the Intensive Care Society, National Outreach Forum, Nursing and Midwifery Council, Royal College of Nursing, Association of Surgeons of Great Britain and Ireland, and the UK Renal Pharmacy Group. The structure is based on the Department of Health framework Competencies for Recognising and Responding to Acutely Ill Patients in Hospital. It defines the knowledge, skills, and behaviours required for safe and effective patient care along the Chain of Response described by NICE.
The Chain of Response reflects escalating levels of intervention in the care of an acutely ill patient, with input from staff with a variety of different backgrounds and skills. The clinical team as a whole must have the competencies to record patient information and vital signs, recognise abnormal values, and institute intervention at a level appropriate to the patient’s clinical condition. A core component of the Chain of Response is the ability to recognise and respond to signs of deterioration in the patient, and to escalate care to the next level if indicated. To facilitate this process, this working group recommended the use of a ‘Track and Trigger’ observation chart for all patients.
The framework covers risk factors for AKI, recognition of early signs and fluid management. I have written to every acute trust with a copy. If you have not seen it downloads one from Aomrc. It is a great tool for induction programmes, team working and CPD.