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THE IMPORTANCE OF MAU NURSING CARE IN THE INITIAL MANAGEMENT
OF ACUTE KIDNEY INJURY: EDUCATION FOR MAU STAFF
Fielding, C 1 , Cooper, R 2 , Selby, N.
3 , Stanworth, R 2 , Willingham, F 3 , Chesterton, L 3
1 Renal Dialysis Unit, 2 Medical Assessment Unit, 3 Department of Renal Medicine, Royal
Derby Hospital
PROBLEM: Acutely unwell patients often have acute kidney injury (AKI). 60% of the patients with AKI in our hospital present with AKI on admission. Prompt assessment and combined medical / nursing management of AKI, is of critical importance to optimise patient outcomes and minimise the long term effects of AKI. However, the majority of patients are admitted to our hospital via our Medical Assessment Unit (MAU) and therefore do not have access to specialist renal nursing care during this initial critical period.
PURPOSE: We hypothesised that the provision of renal education to the MAU nursing staff, would improve the detection and management of AKI in the initial hours of hospital admission.
We aimed to improve their knowledge of AKI and emphasise the importance of nursing care including observations, fluid balance assessment and urinalysis. We also proposed to discuss the common causes of AKI, fluid management in AKI and the management of hyperkalaemia.
DESIGN: We developed a series of 3 simple teaching presentations for the MAU nursing staff.
These presentations were collated using nursing and medical knowledge from both the renal and
MAU teams. Due consideration was given to the intensity of the MAU shifts and the timing of the sessions was arranged to suit nursing requirements. We aimed to provide multiple sessions of each presentation, on MAU in small informal groups, with each session lasting 30 minutes.
We evaluated the sessions using a multiple-choice questionnaire, which was completed by the attendees before and after the sessions.
FINDINGS: The first presentation was delivered on 8 occasions over a 6 week period.
Attendance comprised of 11 sisters, 22 staff nurses, 1 assistant practitioner, 8 healthcare assistants, 3 nursing students and 2 medical students (approximately 1/3 of MAU nursing staff).
The questionnaires demonstrated MAU staff had a good understanding of the initial nursing care in AKI. Areas of least knowledge included the significance of urinalysis results in the context of AKI (10/40 correct pre session) and appropriate management of hyperkalaemia for
AKI requiring acute haemodialysis (18/40 correct pre session). The results of the pre and post questionnaire for the first sessions demonstrated an increase in score after the session was delivered. The mean pre score was 3.74/6 compared to a mean post score of 4.98/6.
CONCLUSION: Key components of the combined medical / nursing management of AKI can be communicated effectively in short, informal teaching sessions. Existing knowledge in the
MAU nursing staff is good and the first set of teaching sessions provided the opportunity to discuss and refresh areas of importance in AKI nursing care. The second presentation is due to start January 2013, with the third in March 2013. We plan to evaluate these presentations in the same manner. In the future, we aim to develop a complimentary learning package, so that educational materials on AKI can be used across the whole team.
RELEVANCE: It is important to recognise the valuable role of nursing staff in the detection and recognition of AKI. It is our intention that the increased knowledge regarding AKI management will directly translate into nursing practice on the MAU department. This will assist the MAU medical and renal teams in the initial management of patients with AKI during this critical period, allowing prompt treatment and improved outcomes and resolution of AKI.