CENTRE FOR PHARMACYPOSTGRADUATE EDUCATION

OPT106October 2017

IntroductionThe National Institute for Health and Care Excellence (NICE) estimates that acute kidney injury (AKI) is the cause of 13 to 18 percent of people admitted to hospital.1 As a pharmacy professional you can help patients and the public understand the importance of kidney health.

This Optimise programme will give you a greater understanding of the biochemical changes that occur during AKI and will encourage you to reflect on how to explain these to patients. You will gain confidence to discuss the meaning of patients’ test results with them and offer sound treatment options. Discussing biochemistry in a person-centred way is important to help patients feel empowered and included in the decision-making process.

Learning objectivesAfter completing all aspects of this programme, you should be able to:

■■ interpret biochemistry results associated with AKI

■■ use relevant biochemistry results to develop appropriate recommendations for medicines optimisation in patients with AKI

■■ take a person-centred approach when discussing biochemistry results.

A CPPE Optimise programme: Biochemistry Focus on acute kidney injury Getting prepared

Lead writer: Anne Waddington, advanced clinical pharmacist, renal medicine, Aintree University Hospital

Aim to understand the patient’s experience – task Anyone can develop AKI. Michael was fit and well before – read his story: http://bit.ly/2vJNDPP

Ensure medicines use is as safe as possible – task■■ Read the information from NHS Scotland on stopping certain medicines when patients are at risk of dehydration:

http://bit.ly/2w87Lfi

Think Kidneys recommends that this advice is now called sick day guidance.

Read the first two sections (What should I know to manage a person with acute kidney injury? and Staging of acute kidney injury) of the NICE clinical knowledge summary: https://cks.nice.org.uk/acute-kidney-injury#!scenario

Make some notes or print a copy for the small group learning session.

Make medicines optimisation part of routine practice - task

Think about the last time you recommended a patient stopped taking their medicines due to AKI (either directly or via the prescriber).

How did you use biochemistry results to aid your decision-making?

Improved patient outcomes

Optimised AKI management will see:

■■ fewer patients requiring acute renal replacement therapy

■■ reduced hospital admissions, length of stay and deaths

■■ improved relationships with patients

■■ improved patient confidence

■■ increased patient involvement in their care

■■ reduced risk of complications of impaired renal function, eg, hyperkalaemia.

Evidence-based choice of medicines – task Look at Think Kidneys’ medicines optimisation guide: http://bit.ly/2xapdg9

Print a copy for the small group learning session.

Clinical decision-makingRhonda is 72 years old and has been referred to A&E by her GP. She is known to have left ventricular heart failure and type 2 diabetes. She has been feeling unwell for five days and is complaining of fatigue, feverishness and dysuria. Rhonda’s GP notes that she has a temperature of 38°C and suspects she has a urinary tract infection (UTI) requiring intravenous antibiotics. She has been having routine blood tests every three months and the results are available.

Rhonda is prescribed intravenous gentamicin and amoxicillin for a complicated UTI, as per the hospital formulary.

Use the information on the handout to answer the questions below.

■■ What risk factors did Rhonda have for developing AKI?

■■ How will you assess the severity of Rhonda’s AKI?

■■ What changes to Rhonda’s medicines regimen would you recommend?

■■ Do you have any concerns about stopping any of her medicines?

■■ What ongoing monitoring does Rhonda need?

Clinical consultationParveen has been admitted to your ward with AKI after experiencing diarrhoea and vomiting. She has type 2 diabetes and is prescribed metformin 500 mg twice a day. Her creatinine is 342 micromol/L and potassium is 5.7 mmol/L.

Parveen tells you she is unsure what the doctors mean when they talk about creatinine and potassium. She is worried that her sugar level is high and asks if she should take her metformin.

What language would you use to discuss the meaning of Parveen’s blood results with her?

How would you approach a discussion about the potential for her to stop metformin?

Clinical controversyIn groups debate the following statement:

Biochemistry results should only be discussed between the patient and the medical team, the pharmacist has no role in this.

Core factsIn your groups discuss the following questions:

■■ what are the diagnostic criteria for AKI

■■ what are the dangerous short-term consequences of AKI?

CENTRE FOR PHARMACYPOSTGRADUATE EDUCATION

Next stepsGo to the CPPE website to:

■■ Complete and record your learning and earn your badge.

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5 minute activity 5 minute activity 10 minute activity

15 minute activity

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Finish 40 minutes

A CPPE Optimise programme: Biochemistry Focus on acute kidney injury Getting prepared