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GP Bulletin September 2015

Tackling Acute Kidney Injury (AKI)

BTHFT is taking part in an exciting collaborative ˜Tackling Acute Kidney Injury' project supported by the Health Foundation which also involves four other Trusts in England. The project aims to improve the prevention, detection and management of acute kidney injury (AKI) in Bradford, thereby reducing patient morbidity and mortality. Weaknesses in the secondary care management of AKI have been highlighted in the NCEPOD report 'Adding Insult to Injury'.

The planned intervention comprises of an automated laboratory AKI detection system (now mandated by NHS England and to be reported in ICE), a linked 'AKI 8' care bundle and a comprehensive package of AKI education for healthcare staff.

We will focus initially on rolling out this project within our acute admission areas, starting with the Medical Admissions Unit (MAU) at BRI. The electronic alert was switched on at BRI on Monday, September 7 and the impact this has on improving patient care will be closely monitored.

New Pain Management Initiative

We are setting up a pain management programme for people living in our community who speak Urdu, thanks to Mohammad Shoaib, a specialised pain management physiotherapist with our Living with Pain team. He is collaborating with other Urdu speakers, including Razia Bhatti Ali, a clinical psychologist; Asim Suleman, a GP with a special interest in pain management; and Mohammad Arshad, our chaplaincy manager, to bring the idea to reality.

The initiative was prompted by the fact that those patients who lack fluent English may not have fully benefited from our standard pain management programme. As a result, we have adapted the traditional pain management programme, making it not only language specific but also culturally specific. Concepts such as self-management, goal setting, pacing and relaxation are not universally known.

After successfully piloting the programme from March to May, the team plans to launch the service fully next month. Patients on the Urdu Living with Pain programme will attend half day group sessions once a week for eight weeks. Topics include mindfulness training and graded exercises. The team will use Urdu language videos and a relaxation CD. Mohammad will also be offering background information about physiology and anatomy and guide patients through gentle, pain-free exercise routines. "Patients say the programme is like finding a light at the end of a tunnel, as they had previously struggled to come to terms with living with persistent pain and lacked access to a language or culturally-specific source of information, he added. The team has produced some educational leaflets, including one titled "Physiotherapy and prayer: information leaflet for Muslim patients. And input from our Chaplaincy service helps to dispel some cultural and religious myths about persistent pain.

National acclaim for Bradford Learning Disability Eye Care Team

The Foundation Trust has scooped a prestigious national award for the high quality treatment provided to patients with learning difficulties. Bradford Learning Disability Eye Care Service was honoured with Vision 2020 UK's Astbury award for excellence for the care it offers across the city.

The team brings together experts from the hospital's eye department, community health, the voluntary sector and education so that access to eye care for adults and children with learning difficulties can be co-ordinated and improved. Sometimes this has meant facilitating eye assessments in a patient's home to accommodate those patients too fearful of coming into a hospital or clinic for examination. And, as an example of the extra mile the team has gone, one recent set of eye examinations took place in a minibus parked outside Bradford Royal Infirmary, as this location was the place where the patient felt most relaxed.

Consultant ophthalmologist Rachel Pilling, added: "We are delighted with our award as it recognises the hard work and effort the whole team have put in to ensuring that we offer the best possible service to our patients. Many of our patients are extremely vulnerable to visual loss but don't do anything about it because they are fearful of attending eye assessments, whether it be in the high street opticians or in the hospital."

The winning team is made up of Bradford Teaching Hospitals' Caroline Rawse (orthoptic special needs and low vision team leader), Louise Outhwaite (head orthoptist), Iftekhar Ahmed (eye clinic liaison officer) and Bradford District Care NHS Foundation Trust's Ruth Foster and Dawn Langwade, alongside Yvonne Smith from Education Bradford.

Neonatal initiative draws clinical praise across print and social media

Our neonatal unit at BRI has been gaining recognition for the way it is at the forefront of providing excellent multi-disciplinary bereavement support to affected families of different faiths and cultures. As well as features in the specialist media covering end-of-life care, the unit's work also found itself trending on twitter.

The unit's work - outlined by Dr Chakrapani Vasudevan, consultant neonatologist, and Suzi Minchella, a senior sister “ triggered great interest across the clinical community and beyond.

There are around 15-20 neonatal deaths every year within our neonatal unit. Caring for infants and families around the time of death, whilst addressing the expectations of all the families within the different and diverse cultures of the Bradford area, poses additional challenges as there is not a "one size fits all package of support.

As a result, the unit launched a dynamic Neonatal Bereavement Support Group, represented by a diverse mix of health professionals including neonatal doctors, nurses, outreach midwives, community palliative care specialist nurses, psychologists, hospice professionals, chaplaincy and parent representatives. It provides unique end-of-life care to families both antenatally and postnatally. The team provides a consultant-led multidisciplinary service that offers support and care to the baby and family in the hours leading to death. It also offers a follow-up provided by the neonatal consultant and nurses / outreach midwives who have previously engaged with the family.

The families are offered a choice of hospice support during care, though most families choose hospital-led care potentially due to the geography and social circumstances. There is a choice of bereavement suites and bedrooms within the hospital that we offer to the families where we can accommodate the extended family and allow them to spend precious time together. The group has reviewed existing practices over the last 18 months and transformed the way in which we support and create memories for the families and enable sensitive transfer to home or mortuary after death. It has procured cameras, memory sticks, memory boxes and comfort care packs to be used around the time of palliation. In order to accommodate the varying religious beliefs and to be truly inclusive, it has devised a faith-specific memory box for our Muslim families in close liaison with the chaplaincy team. And kind donations from charities and voluntary organisations have enabled the group to provide families with comfort packs that contain clothes, toiletries, children's books etc

An invitation to the Grand Round

The Foundation Trust invites all local GPs to attend the Grand Round. These meetings provide an excellent opportunity to meet with fellow professionals whilst remaining up to date with key issues and developments.

The next Trust Grand will take place on 29th September. The subject presented will be -

¢ ˜Tackling Acute Kidney Injury' by Consultant in Nephrology and General Medicine, Dr John Stoves.

The Grand Round is held in the Sovereign Lecture Theatre at Bradford Royal Infirmary on the last Tuesday of each month. Meetings start at 12.45pm and last for an hour. Lunch is available from 12.15pm.

This monthly bulletin aims to keep local GPs up to date with the trust's new services and developments. If you'd like any further information about any of the items in this month's briefing contact Naveed Saddique on 01274 272635, email gp.comments@bthft.nhs.uk