• Run by Betsi Cadwaladr University Health Board, in partnership with University College London Partners, Aneurin Bevan University Health Board, Helen Hamlyn Centre for Design, 1000 Lives Plus and Bangor University.
  • Implemented in hospitals in Wales and London.
  • Aimed to improve the safety of patients at risk of acute kidney injury and sepsis.
  • Developed a system of icons that translate complex information into simple visual prompts to signpost risk to patients, carers and clinicians at the bedside.

This Betsi Cadwaladr University Health Board project involved developing a toolkit of signposting methods to define responses to acute kidney injury and sepsis; two of the most common causes of avoidable harm to patients admitted to hospital.

Life-saving information that is crucial for the safe management of patients at risk of these two conditions is often buried in bulky records. This project aimed to develop a system of icons to guide the behaviour of health care staff, patients and their carers at the bedside.

A suite of four interrelating interventions were developed and tested at six hospital sites in two clinical networks in London and Wales:

  • Patient diaries whereby patients document their fluid input and urine output
  • A KidneySafe Bracelet that depicts urine colours
  • A WeeWheel that quantifies whether a patient’s urine output is enough to maintain renal function
  • A SepsisPanel, a panel of icons relating to the diagnosis of sepsis.

The project has shown that visual prompts can significantly enhance clinicians’ intuitive understanding of the interventions required for acute kidney injury, and result in measurably different behaviour for monitoring patients at risk. It has also shown that patients can contribute to their own hospital records and therefore support their own safety.

Overall, it has demonstrated that visual information is likely to improve the safety of patients at risk, with little or no extra workload for staff and at minimal cost.

The biggest challenge of the Safety = Design project was the broad geographic spread of the partners and the complexity of multiple interventions being used for several key safety risks. 

Supporting dissemination

This project was given further support through a Spreading Improvement grant to help disseminate learning and maximise the impact of the approach across the health service in Wales.

Funding will be used to make the suite of interventions from the original project available to hospitalised patients and their clinical teams in all Welsh NHS hospitals through a variety of activities. Additional resources will be developed to support online training in the use of the finalised Acute Kidney Illness (AKI) toolkit, a coalition will be supported to engage national stakeholders and potential champions to help combat AKI, and nudge techniques will be employed to encourage staff to collect process measures of implementation.

Contact details

For further information about the project, please email Dr Christian Subbe at Betsi Cadwaladr University Health Board.

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