Network achievements

Network Achievements

Building the network and supporting collaboration

LAKIN has recruited a multidisciplinary pan-London board and Trust AKI leads across London (around 80 clinicians in total). This has been essential to agree cross-organiaational and cross-disciplinary policies while supporting team-working and sharing of best practice.

Raising awareness, agreeing policy and sharing best practice

  • LAKIN initiated in March 2012 with a large cross-London launch event with 150 delegates.
  • Since March 2012 we have held a sequence of around 25 sub-regional committee meetings between AKI providers in 5 London sectors to share best practice and strengthen cross-pathway team-working.
  • We have supported this sub-regional work with a sequence of pan-London strategy and information-sharing meetings of the LAKIN Board (8 events in total).
  • We held a LAKIN biochemistry forum in January 2014 to support local implementation of laboratory AKI e-alerting. This successful event, chaired by LAKIN biochemistry lead Anne Dawnay, was attended by more than 20 London biochemists.
  • We hosted a January 2014 research and innovation forum to promote AKI research collaboration in London.
  • In October 2015 we held two speciality AKI forums on AKI in HUS and pregnancy. These events were attended by a wide group of clinical stakeholders. Key outputs of these events were agreed London pathways for AKI in HUS and preganancy.
  • In November 2014 we held a pan-London sharing best practice and innovation event. This free event, to showcase local and network improvement projects and launch new products sold out to 150 capacity within 2 weeks of advertising resulting in a lengthy waiting list for places.

Improving AKI care through innovation and collaboration

  • We developed and implemented a London AKI Pathway and Guideline synthesising various National guidance and ratified by the majority of London Trusts through Trust AKI leads. This has been operationalized through Trust guideline committees. This includes basic AKI bundles, referral and transfer criteria, AKI prevention, perioperative AKI, management of AKI complications and fluid therapy. Of note this was the first regional deployment of a standardised AKI care bundle. This work has been adapted by several other regions and local centres. It has also appeared in several texts and publications and is used as core AKI material in the Oxford Handbook of Nephrology. These pathways are accessible via londonaki.net and our mobile app and are widely viewed in London and beyond. This resource was expanded with new pathways in 2015 and underwent a full update in line with NICE clinical guideline 169 and NICE quality standard 76.
  • We have performed pan-London audits on renal unit transfer times, critical care occupancy with AKI, basic AKI care and outcomes after AKI dialysis in renal units.
  • We have formally surveyed our organisations to assess levels of organisational compliance and implementation of AKI standards.
  • We pioneered an approach of standardised, regional secondary care AKI alert implementation across NC, linking to agreed guidance. We supported more heterogeneous implementation of e-alerts in 60% of London trusts total, prior to 2014 NHSE alert. This work has been presented at numerous National meetings and published. Our biochemistry lead continues to provide informal advisories to trusts implementing e-alerting. This alert was linked to our online guideline repository. This work is now being transitioned by Trusts in line with the NHS England patient safety alert.
  • Implementation of primary care AKI alerting in 2012-2015 in North Central London. This project has undergone an evaluation that was recently presented at the European Renal Association. We believe this is the first implementation of community AKI e-alerting in the UK.

Supporting and delivering AKI education

  • We have developed a unique online resource for AKI education (londonaki.net). This compiles clinical guidance with online educational materials including an extensive selection of educational videos and presentations. This content aligns with locally adopted clinical policies. This resource was expanded in 2015 to include updates and new pathways.
  • l>In 2012 we launched londonAKI – the worlds first mobile application dedicated to AKI management. In 2015 this was expanded in content and launched in iOS9 for iPhone, iPad, Android. This was supported by an apple ibook with embedded video content.
  • We have created the UKs first online resource for AKI patients and relatives (www.londonaki.net/patients). This resource, which went live in 2012, includes advice, links to support charities and agencies and a video presentation of Michael Wise’s AKI survivor story. This resource was further expanded in 2015 with ‘My AKI: A patient’s guide to acute kidney injury’ and further video materials.
  • In December 2012 we held out first AKI Academy – a 2-day, multidisciplinary course on AKI management for healthcare professionals. We repeated this course in October 2014 with an expanded format including workshops and high-fidelity clinical simulation. We will repeat the academy in 2016. The AKI Academy his is the first regular, recurring AKI course in the UK.
  • Network clinical leads and members have used LAKIN, and local, resources to deliver multidisciplinary education at undergraduate and postgraduate level across London.

Advice, advocacy and influence

  • London AKI Network has provided support to Think Kidneys and several other projects including prior NHS Kidneys Care programmes (such as the National Audit) and an HUS preparedness project.
  • Advocacy for AKI improvement and the AKI network approach has been provided at several regional and National forums including the 2013 UK Renal Association, 2013 Renal CD Forum, The 2014 Future Hospital Commission launch event, the 2014 Joint UK-France Renal Associations ‘Entente Cordiale’ meeting, the 2014 Irish Society of Nephrology and the Intensive Care Society 2015 State of the Art meeting.
  • We have made numerous presentations of specific projects at societal meetings.
  • We represent London AKI patients at National forums.
  • We have shared resources freely with local and regional AKI teams outside of London, many of which have been adapted for local use.
  • As of Autumn 2015 there were AKI Networks, or AKI programmes embedded in regional Strategic Clinical Network programmes, across England.