Haemodialysis team members, who provide dialysis and care to kidney patients at University Hospitals of North Midlands NHS Trust (UHNM), were honoured to be nominated and then become finalists in the BJN Awards 2020. The team were shortlisted in the Renal Nurse of the Year category for their work developing an information card for patients with kidney disease.
The BJN Renal Nurse of the Year Award celebrates the hard work and dedication of nurses working in clinical practice across all areas of renal care. For this category, the judges looked at what the team contributed to renal nursing, how this has impacted patient care, how their work will continue to support renal nursing and evidence to support this contribution.
The ‘Hyperkalaemia Alert Card’ provides information to patients about their condition and risk factors associated with high potassium levels. It also alerts other health professionals to the risk and need to take urgent bloods if hyperkalaemia—a higher than normal potassium level—is detected.
The cards are now being given to all UHNM patients receiving haemodialysis at any of its three specialised units.
The renal team devised and implemented the information card for all their haemodialysis patients to carry and present to any health professional if they become unwell. This card will alert other health professionals to consider whether the patient is unwell because of raised potassium levels, which is a medical emergency and can lead to cardiac arrhythmia (ECG changes) and, in the worst case scenario, cardiac arrest.
This innovation was put in place after a renal patient presented to the busy UHNM emergency department generally unwell 2 days post-last dialysis. The patient's blood potassium was found to be elevated, but this risk was not considered at triage and only discovered when bloods were taken a few hours later. Had the raised potassium been discovered earlier, urgent dialysis could have been delivered sooner.
The card is wallet/purse-sized and red in colour and the message is clear and concise. The card was devised with input and guidance from the whole haemodialysis team and wider renal team and also across the Trust through relevant governance meetings and committees.
The overall aim was to prevent delays in checking potassium levels in any renal patients presenting to other services or departments in a bid to prevent patient harm from undetected and non-treated hyperkalaemia.
The cards cost just £125 for 500, which is a minimal cost to save a life or lead to patients having urgent treatment in a more timely way. The team were very fortunate that Kidney Care UK agreed to fund the initial supplies so this was a cost-neutral initiative to the organisation. Kidney Care UK were keen to see its valuable donations being used to benefit patients and did not hesitate to help. The UHNM renal team were grateful for its support.
The implementation of the card has also been another opportunity to work with and educate renal patients on the risks of hyperkalaemia and the importance of low potassium diets and the symptoms to look for when levels are high, such as muscle weakness and ECG changes.
This card will prompt other health professionals, such as GPs and paramedics, to take urgent action if renal patients present feeling unwell in a non-renal environment, and to check for high potassium levels. This card should be passed to health professionals by patients during any contact.
The cards have been received well by the patient group and their next of kin. Our teams across UHNM have commended the card and have welcomed its implementation. Emergency department and acute medical colleagues feel it is particularly useful, especially when junior doctors are the first to see such patients in these departments.
Entering these Awards has given the team the opportunity to share this simple idea in the hope that other renal teams nationally could easily replicate the idea for improved patient care.