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New report highlights the importance of NICE guidance in the care of acutely ill people in hospital

A new report produced by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) has recognised the importance to patients of NICE guidance in the care of acutely ill people in hospital.

The report titled ‘Acute Kidney Injury: Adding Insult to Injury' (2009), looked at the process of care for 564 patients who died in hospital with a primary diagnosis of acute kidney injury (AKI). The report paid special attention to areas where the care of patients might have been improved. The key findings related to the investigation and management of AKI were:

  • 33% of patients had inadequate investigations - basic clinical examination and simple laboratory tests.
  • 29% of patients had inadequacies in clinical management of AKI. Lack of physiological monitoring was common.
  • 63 of the patients with AKI did not have urinalysis performed.
  • Recognition of acute illness, hypovolaemia and sepsis was poor.

Professor Peter Littlejohns, Clinical and Public Health Director at NICE explains “Patients who are, or become acutely ill in hospital, need prompt and effective treatment, yet this report shows that some patients with a primary diagnosis of acute kidney injury (AKI) may not be receiving this.

“In July 2007 NICE published guidance for the NHS on the monitoring and treatment of acutely ill patients in hospital. The guidance delivers clear advice on recognition, assessment and prompt management of the patient who is becoming more ill during their stay in hospital.

“The recommendations made in the guidance emphasise the importance of a full clinical assessment, regular observations and increased communication between critical care and ward staff. These recommendations aim to ensure continuity of care, as well as provide reassurance and information to patients and their carers at a time of great anxiety."

NCEPOD has recommended that NHS trusts put in place a mechanism to ensure NICE guidance for recognising the acutely ill patient has been implemented. In particular all acute patients should have admission physiological observations performed and a written physiological monitoring plan made, taking into account the degree of illness and risk of deterioration.

The purpose of NCEPOD is to help maintain and improve standards of medical and surgical care by reviewing the management of patients and undertaking confidential surveys and research.

1 July 2009

This page was last updated: 12 July 2010

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Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.