hpe live talk 10112016
TRANSCRIPT
Think(ing) KidneysReducing the impact of AKI in secondary careDr Richard [email protected],Chair, Think Kidneys
01/05/2023
Objectives
1) What is acute kidney injury?2) Why is it important?3) How is it diagnosed?4) What treatment is required?5) What about recovery from illness?6) Specific issues around medicines management
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An ‘intermediate’ health stateAssociated with other serious illness
Important marker of illness severity
“Force multiplier” for poor outcomes
Potential to improve care
Reduce avoidable harm - death and morbidity
Reduce cost
Acute Kidney Injury National Programme | Richard Fluck
01/05/2023KDIGO Clinical Practice Guideline for Acute Kidney InjuryKidney International Supplement 2012; 2(1): 1-138
How is AKI defined?
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‘Think Kidneys’ AKI Programme
Who is at risk?
When do people sustain AKI?
How should patients with AKI be
managed?
What do people need to know?
Risk Detection
Treat Recover
Education
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Risk http://bit.ly/1TGGphDNon modifiable or fixed factors
AgeCo morbidities - CKD
Modifiable factorsDrugsExposure to new drugs and
contrastVolume
TriggersSepsisHypovolaemiaHypotension
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Risk scoring and equations
DrugsACEi/ARB, NSAIDS, diuretics or contrast
Total score Low < 5 High >= 5
If high risk
Daily U&EsReview medicinesAssess fluid status and balance
Derby Risk Score (unvalidated)AgeAge > 75ClinicalHypotensionSepsisHypovolaemiaComorbiditiesKnown CKDCCFAtherosclerotic vascular diseaseLiver Cirrhosis
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Improving diagnosis: using changes in serum creatinine
Laboratory definition and standardisation
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Detect Alert
Lets talk about ‘alerts’
Respond
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AKI Warning stage
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Care bundles http://bit.ly/27Xxn9I
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Review of care bundles
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Nephron 2016;134:195-199
Adjusted survival curve stratified by timing of completion of the AKI-CB.
Nitin V. Kolhe et al. Nephrol. Dial. Transplant. 2016;31:1846-1854
© The Author 2016. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.
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Key pointsFew drugs are ‘nephrotoxic’ – avoid use of word
Most drugs are ‘situational’ in cases of AKI
1. Causative - rare2. Adjuncts – renal perfusion - common3. Altered side effect profile
Role in reducing risk of AKISick day guidance position
statementhttp://bit.ly/22sGdbs
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Medicines management http://bit.ly/1TNSGTD
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Year 1Discharge communicationCommunication of AKINeed for follow upMedication reconciliation
Why?High readmission ratesPrimary care knowledgeFuture riskMedicines management
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Commissioning: national CQUINKey points for Quarter 3 2015/16:AKI data collection
Overall, case notes from a sample of 7,784 covering 31,136 key criteria for AKI. This is an increase of 8% since Quarter 2 (28,869 items)A rate of 55% (17,113 items) were completed in the review of AKI discharge summaries. A 60% increase of compared to Quarter 2 (10,668 items)All the NHS regions (London, North of England, South of England, Midlands and East of England) achieved between 51%-63% completed items (an increase in from 25%-39% in Quarter 2).
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Patient information http://bit.ly/1qTXKM0
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Public awareness campaign http://bit.ly/1OViw3K
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www.thinkkidneys.nhs.uk A summary
Think Kidneys
Has delivered system leversProviding a framework for actionRaised the profileIt is supportive of other change agentsPharmacists have a key role:risk, treatment and recovery
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Karen ThomasThink Kidneys Programme ManagerUK Renal [email protected]
Annie TaylorCommunications Consultant to the Acute Kidney Injury National [email protected]
The UK Renal Registry team, chairs, co-chairs and teams of all the workstreams in ‘Think Kidneys’
Joan RussellHead of Patient SafetyNHS [email protected]
Ron CullenDirectorUK Renal [email protected]
www.linkedin.com/company/think-kidneys
www.twitter.com/ThinkKidneys
www.facebook.com/thinkkidneys
www.youtube.com/user/thinkkidneys
www.slideshare.net/ThinkKidneys
www.thinkkidneys.nhs.uk
Acknowledgements
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