Reflective Template:  Quality Improvement Activity (QIA)

This reflective template has been designed to use with SOAR (Scottish Online Appraisal Resource).  On completion, please upload this to SOAR for submitting to your appraisal to share with your appraiser.	3-step guide to completing this form:

1)	Save this form (using “Save As”) to your computer (e.g. My Documents, Desk top), and rename the file (e.g. QIA Reflection 2021)
2)	Proceed to filling out the form - when finished, Save and Close the document.
3)	Login to SOAR and Upload this file from where you had saved it (from step 1) to your current appraisal.	

The boxes will expand automatically as you type into them.
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What supporting information have you provided for your QIA?
I have uploaded an audit study of the outcome of patients undergoing nephrostomy for obstructive uropathy with hyperkalaemia. There was concern in the department that hyperkalaemia increased the risk unacceptably and should be corrected before the procedure. 	

What strengths or achievements does it demonstrate?
The study confirms the findings of other workers that the serum potassium level itself is not a major hazard in these patients. Our study suggests that obstruction with evidence of infection or due to stone disease (because of the sepsis associated with stones) is more likely to cause dysrhythmias. Other studies indicate that the rate of change of the potassium and other serum electrolytes is more hazardous than the absolute level. Haemofiltration and other measures to treat hyperkalaemia are not particularly effective at normalising serum potassium and not without hazard.	

Did you encounter any difficulties in this process?
No.	

Have you been able to make any changes as a result of undertaking this activity?
When considering a patient for nephrostomy, I should be more careful with patients likely to have sepsis and less worried about hyperkalaemia. 	

What have you learned from undertaking this activity?
The situation is often not quite as it first seems.	

Is there anything else that you would like to/ need to do to follow it up?
For patients with sepsis, we should look at the benefit of 12 hours aggressive antibiotic treatment before nephrostomy drainage.