stakeholder event master slide deck final

Think Kidneys Programme Team

Forward Planning Away Day

29th April 2015

Welcome, housekeeping and

plan for the day

10.00-10.10

Annie Taylor Communications consultant to the Think

Kidneys Programme

Housekeeping

29.04.2015 Think Kidneys Programme Team Forward Planning Away Day

@ThinkKidneys

Programme for the day

10:00 Welcome, housekeeping and plan for the day

10:10 Question Time – Mike (Paxman) Jones interview with Richard Fluck

10:30 Workstream updates – top achievements over the last 12 months

11:15 Trios approach – lessons learned, key learning

11:55 Workstream Timelines and priorities and interconnections

13:00 Lunch

13:40 Quality improvement

14:10 Workstream requirements

14:50 Workstream feedback

15:05 Role of the commissioners

15:50 Summary of the day

16:00 Close

Think Kidneys Programme Team Forward Planning Away Day 29.04.2015

Question Time

10.10-10.30

On the sofa with Mike (Paxman) Jones

Interview with Richard Fluck, Chair of the Think Kidneys national programme

Workstream Updates

10.30-11.15


Detection Workstream

Nick Selby

Consultant Nephrologist

Royal Derby Hospital


Events as they happened


• LIMS suppliers slipped their deadline of December 2014 to the safety alert deadline of March 2014

• Issues with software from both of the UK’s major LIMS suppliers despite their testing against the test script

• Both suppliers maintain a positive attitude towards producing fully functioning software

• No serious challenge to the algorithm though some clarification questions about the logic

• Deadline passes with the big two LIMS suppliers making assurances that all labs will be operating with the new AKI warning software by end April 2015

Detection works stream supportive action


• Face to face visits to LIMS suppliers along with colleagues from the measurement work stream

• Fielded enquiries from the renal registry email helpline

• Set up a JISCMAIL internet discussion forum. Archived monthly discussions available from July 2014. Used by both detection and measurement workstream and is available to other workstreams

• Intervened at least monthly to moderate discussions on JISCMAIL. Give guidance based on the NHS England view.

• Produced a “best practice” guidance document for implementing the AKI warning algorithm. Available on the “Think Kidneys” website

• Monitored the integrity of the algorithm and implementation issues on the ground via the algorithm sub-group

• Responded to BMJ article which urged caution when interpreting AKI warning stage test results. Published in February 2014 electronic version BMJ

Remaining challenges


• Monitoring the smaller LIMS suppliers and their compliance

• Managing anxiety amongst labs who are on the cusp of implementing

• Getting Trusts (not just labs) to engage with the clinical aspects of implementation

• Understanding how to translate a test result into an alert (see last slide)

• Putting together an audit of the algorithm’s clinical effectiveness among early adopters

LIMS level ‘result’ Patient

management system

Alert Response

Local systems

Message

Master patient index

Other data systems

AKI Registry

Regional National

Research

QI

Measurement Workstream

Nitin Kolhe

Consultant Nephrologist

Royal Derby Hospital


Approval to collect data

• The UKRR applied for National Information Governance Board’s

(NIGB) approval to collect patient identifiable data for Acute kidney

injury (AKI) patients in England

• The Health Research Authority granted the UKRR exemption from

section 251 of the NHS Act 2006 for the purpose of collecting data

relating to acute kidney injury.

• This will allow UKRR to hold personal identifiable data without

individual patient consent for the longitudinal follow up of cases and

linkage to other healthcare databases

Master patient index

The UKRR applied for National Information Governance Board’s (NIGB) approval to collect patient identifiable or Acute kidney injury (AKI) patients in England

The Health Research Authority granted the UKRR exemption from section 251 of the NHS Act 2006 for the purpose of collecting data relating to acute kidney injury.

This will allow UKRR to hold personal identifiable data without individual patient consent for the longitudinal follow up of cases and linkage to other healthcare databases

• A final specification for the master patient index (MPI)

was developed and sent to LIMS suppliers, which will

enable the UK renal registry to identify core

information about the extent of AKI in England.

• The data specification was modified to include serum

creatinine 15 months before and 15 months after the

first AKI stage warning test.

• A best practice document was uploaded on Think

Kidneys website.

LIMS Suppliers

• One to one meetings were held with major LIMS suppliers.

• Making labs and Trusts aware that central reporting of AKI

warning test results was also mandated by the National

Patient Safety Alert issued in June 2014.

• Meeting with middleware company (CSC) Dec 2014

• Checked data transfer from the Trust to UKRR.

• Dedicated email help line for Trust or LIMS supplier to contact

in case of any queries.

Check data transfer

• We ensured data transfer between Trusts and

UKRR was feasible.

• Tested data items and refined format of data

items.

• Ensured alert and creatinine files were

received by UKRR


Analysis Plan

Task and finish group for analysis plan in March 2015

Analysis in 3 phases

1st phase: Reporting of data completeness

2nd phase: adding of date of admission to core data set

and establishing linkage with HES

3rd phase: reporting data at patient level, CCG level, Trust

level including incidence, progression of AKI and other

outcomes.


Linkage

• We plan to discuss with HSCIC for future linkage to

obtain other core data items

• We also plan to link UKRR AKI dataset of RRT

requirement in UK to obtain data regarding need for

RRT and non-recovery of AKI

• Linkage with National Diabetes and CKD audit will be

performed in 2016


Risk Workstream

Andy Lewington

Consultant Renal Physician

Leeds


Update

Risk Cases

• Developed case studies of patients at risk of acute

kidney injury

Communities at risk document

• Document describing the communities who are at risk

of acute kidney injury

• Acting as a portal to other areas on the website

Update

AKI risk calculator for secondary care

• Members of the group have been collaborating

AKI risk calculator for primary care

• Paul Roderick collaborating

Patient leaflet

• Fiona Loud and BKPA

Education Workstream

Mike Jones

Acute physician

University Hospital Durham


Aims

Increasing awareness of AKI in healthcare professionals Ensure educational products are consistently of high quality Increase general awareness of kidneys and their function

28.11.2014 Acute Kidney Injury National Programme | Introducing the Think Kidneys campaign | Karen Thomas | 23

Achievements

Identification of educational products that already exist Negotiating with NICE for endorsements of educational products Running events for primary care, for pharmacists. Developing changes to primary care curriculum Running public campaign to increase general knowledge of kidney function and hydration

28.11.2014 Acute Kidney Injury National Programme | Introducing the Think Kidneys campaign | Karen Thomas | 24

Implementation Workstream

Nesta Hawker

Regional Programme of Care Manager

Internal Medicine (North)

NHS England


Achievements

• Developed and implemented a CQUIN for secondary care. Now in second year.

• Developed and implemented a local enhanced service for primary care.

• Recruitment of Salford CCG and the sick day rules project.

• Recruitment of additional CCGs to the work stream.

• Development of a commissioning lever for use with care homes.

Future Aims

• Reform as a commissioner expert stakeholder group meeting quarterly face to face

• Develop a commissioner tool kit for the Think Kidneys website to include:-

• Lessons learnt from the CCGs implementing commissioning levers

• Examples of commissioning levers to cover the patient pathway

• Links to available data on performance and outcomes


Intervention Workstream

Charlie Tomson

Consultant kidney specialist

Freeman Hospital, Newcastle on Tyne


Intervention workstream

Leariann Alexander Caroline Ashley Tom Blakemore Jude Clarke Jan Flint Patsy Hargrave Claire Huckaby Suren Kanagasundaram Ed Kingdon Caroline Lecko

Chris Mulgrew Marlies Osterman Rajib Pal Rukshana Shroff Laurie Tomlinson Charlie Tomson Emma Vaux Sue Wilson Bob Winter + 2 Scottish observers

Discharge summaries following inpatient AKI

Aim: to set minimum standards for content e.g. Mentioning that the patient had AKI!

Severity/duration/RRT

Drug treatment: which drugs to re-start and when

Frequency and duration of monitoring of kidney function, and

how to act on the results

Linked to national NHSE work on discharge summaries

Secondary care ‘bundle’

Draws on many successful examples from around the UK

– mostly very similar in content

Includes ‘escalation triggers’ based on NICE CG50

Use piloted in several Trusts early 2015

Final version available following revision in light of

feedback: for endorsement by stakeholder groups

Medicines management toolkit

Comprehensive advice for prescribers on drug treatment,

dose adjustment & drug withdrawal in the context of AKI

Successfully piloted in secondary care and modified in

light of feedback

Now working on a similar toolkit for primary care

? Incorporate advice into decision support systems/apps

Dietetic management

Advice on dietetic management of inpatients with AKI

being prepared

“Sick day rules”

Bristol CLAHRC undertaking formal evidence review

Plan to use this to build consensus with other

stakeholders e.g. British Hypertension Society, British

Society for Heart Failure

Interim position statement being prepared for Think

Kidneys website

Changes in kidney function during Rx of heart failure

Complex pathophysiology - effects of venous congestion,

systemic hypotension, effective hypovolaemia, ARAS, renal

autoregulation etc on GFR

Potential for confusion between BP, HF, AKI and CKD guidelines

Formal literature search under way: this will be used to

generate consensus statement (BSH, BHS, RA, RCGP, others)

Questions & Answer Session

Facilitated by Richard Fluck


Workstream Group Exercise

11.15-11.55

Trio approach


Step one – five minutes

Each person to take some post it notes

On your own put down your initial answer to the three questions posed below

Label the post it note A, B or C depending on which question it

relates to

You can give more than one answer to an individual question but

each answer needs to be on a separate post-it note

Question A – What are the key learning points from the programme to date?

Question B – What is the Think Kidneys legacy – what work do we need to

complete before the end of the programme?

Question C – How are we going to ensure that the work of Think Kidneys is

sustained beyond April 2016?


Scaling up – ten minutes

Get together in three (trios) One person is A and all answers related to question A are

discussed and passed to this person

One person is B and all answers related to question B are

discussed and passed to this person One person is C and all answers related to question C are discussed and passed to this person


Final Stage – fifteen minutes

Around the room are 3 templates labelled A, B and C The person who has all answers from the trio labelled A goes to

the A area in the room etc. Once at the flip chart the post it notes are grouped into themes

and stuck on the template Work with your other A colleagues etc to group them

Have a discussion in the A, B, or C area and agree who will feed the themes back into the room


What are the key learning points from the programme to date?

QUESTION A


What is the Think Kidneys legacy – what work do we need to complete before the end of the programme?

QUESTION B


How are we going to ensure that the work of Think Kidneys is sustained beyond April 2016?

QUESTION C


Trios approach feedback

Trio approach


Working in workstreams 11.55-13.00


Working in workstreams – 50 mins incl group feedback


• In your workstream group you will find your project plan with timescales.

In addition there will be a blank timeline template and your key

deliverables will be found in a plastic wallet. Please review these

timescales and using blue tack please fix your deliverables to the blank

timescales with a realistic timeframe. - Time allocated for this session is

20 minutes

• The second part of this group work will be to use the two blank wheel

templates that are in your workstream group – can you consider what

your workstream can offer the other workstreams and what the other

workstreams can offer you – Time allocated for this session is 20 minutes

• Prepare 2 minutes feedback to the wider group

Workstream Timeline

April 2015

May 2015

June 2015

July 2015

August 2015

September 2015

October 2015

November 2015

December 2015

January 2016

February 2016

March 2016

Use the timeline below and your priorities from your project plan to review what your priorities will be over the next twelve months.


What can you offer the other workstreams?


What can the other workstreams offer you?


Working in workstreams feedback



Lunch

13.00-13.40


Quality Improvement

How can the improvement organisations help

implementation for Think Kidneys?

13.40-14.10


Sign up to Safety

Joan Russell

NHS England


As of April 20th

250 orgs signed up

Safety Improvement Plan (SIP) Priorities (as Feb 2015)

AKI – rank 12th out of 34 priorities

Su2S & Think Kidneys working together

• AKI webinar for Su2S community with Richard scheduled for 3 June.

• Sign post Su2S community to Think Kidneys website and resources

• Su2S can amplify and TK coms messages, news stories, new resources to the Su2S community via Twitter, website and weekly SignUPdate newsletter

• Su2S orgs working on AKI in their SIPs will be offered opportunity to connect and work together on solutions/implementation (if they wish)

• Su2S can share intel (with permission) about AKI improvement activity, innovative practice, case studies discovered via Su2S webinars, networking and other coms activity with TK.

Patient Safety Collaboratives

Barbara Zutshi

NHS Improving Quality


Improving quality, safety and lives –

Supporting the Patient Safety

Collaborative Programme

2014 - 2019

NHS Improving Quality

Think Kidneys Stakeholder Consolidation Awayday Barbara Zutshi 29 April 2015

“Following Don Berwick’s recommendation, NHS England will establish a new Patient Safety Collaborative Programme across England to spread best practice, build skills and capabilities in patient safety and improvement science, and to focus on actions that can make the biggest difference to patients in every part of the country. They will be supported to systematically tackle the leading causes of harm to patients. The programme will start in April 2014.”

The government’s response to Francis and Berwick, November 2013

Responding to Francis and

Berwick

• AHSN footprint - 15

• 2-5m population

• Locally owned and led

• Designed in

partnership

• Funded for 5 years by

NHS England

• Majority of funding

devolved to support

local improvement

programme activity

• Variation on traditional

breakthrough model

Patient safety collaboratives

The collaboratives will:

• bring together patients, healthcare staff and other partners from across the health and care economy to determine their local patient safety priorities and to develop and implement solutions to these problems.

• support individuals, teams and organisations to build skills and knowledge about patient safety and quality improvement to create space and time to work on the challenges, and provide opportunities to learn from each other.

PATIENT SAFETY PRIORITY MATRIX

Topic specific cluster groups

• Led and coordinated by the AHSNs

• Groups focus on topic specific improvement – taking

into account the need for matrix working as many

themes are cross cutting (care homes)

• Build on and link to existing work where appropriate

• Stop the pressure

• AKI national programme

• Sign up to Safety

Cluster groups

While one size will not fit all, the primary framework of

each cluster group should ideally be to provide:

• Stakeholder input

• Shared and accelerated learning nationally

• Peer support and problem solving

• Innovation and creativity

• A forum to access expertise

NHS England and NHSIQ available to provide

knowledge expertise and QI as required

Medications

• Greater Manchester

• North East North Cumbria

• Yorkshire and Humber

• Eastern

• West Midlands

• HIN South London

• Kent Surrey Sussex

• Oxford

Acute Kidney Injury



• North West Coast (Hydration)


• Oxford

• UCL Partners

• West of England

• South West Peninsula

Pressure Ulcers


• East Midlands

• West Midlands

• Eastern



• Oxford

Mental Health

• West of England


• Kent Surrey and Sussex

• Wessex

• Oxford


Deteioriation and Sepsis

• East Midlands

• North West Coast

• West Midlands



• UCL Partners

• West of England

• Wessex


Cluster Groups

Leadership and Culture

Leadership and Culture

Measurement and Evaluation Measurement and

Evaluation Capability Building Capability Building

Patient and Public Voice

Patient and Public Voice

Primary and Secondary Care Social Care and Voluntary Sector Community and Mental Health

THANK YOU

[email protected]

#saferNHS

Improving health outcomes across England

by providing improvement and change expertise.

Local AHSN perspective

Chris Laing

Royal Free Hospital


Regional networks for implementation in AKI

Chris Laing Think Kidneys Programme Board

Chair, London AKI Network (London Strategic Clinical Network)

AKI Lead UCL Partners Patient Safety Collaborative

• NCL AKI network 2010

• London AKI Network 2012 (7 renal units, 9-10M)

• Post-NCEPOD

• Trust representatives (appointed executive), multidisciplinary/speciality

• Agreed guidelines, pathways, educational resources, broad framework for trust implementation, sharing best practice, E-alert (secondary and primary care), cross-London audits, advisories, advocacy

• 2013 Strategic Clinical Network (renal) -formalised structure

• Implementation of ‘think kidneys’

• AKI standard and pathway for London (including some speciality pathways) and resources to help

• Data, operational function, strategic commissioning, structured QI, (clinical trials)

• All English SCNs have an AKI programme

• UCLP AKI collaborative (patient safety programme)

• NCL, NEL, Essex and Hertfordshire (6M)

• Kent, Surrey, Sussex progenitor

• Structured, intensive improvement programme (more direct support of implementation)

• Engagement (leads and exec teams), partnership agreements, continuous measurement, regular learning sessions, capability building, site visits (IHI Breakthrough Collaborative Model)

• Clinical leadership programme

• Primary care programme

• Measurement and interaction with registry key

Think Kidneys

Renal Strategic Clinical Networks

Regional Improvement

collaborative

Inhouse

Improvement programme

• Lots to implement (NCEPOD, NICE CG, NICE QS, NPSA alert, CQUIN, National consensus conference, societal best practice and Think Kidneys)

• Regional networks (SCNs) are a route to implementation, AKI collaboratives are a route to more intensively supported improvement work

• Key stakeholders

• Innovation from below then scale

Local SCN perspective

Fiona Cummings

East of England Strategic Clinical Network


Local SCN activity

around AKI

AKI

Fiona Cummings

Quality Improvement lead – renal

East of England Cardiovascular Clinical Network (formally SCN)

AKI

What do we do? Support change across health and care systems to improve health outcomes by connecting:

• Commissioners

• Providers

• Patients

• Public

• Third sector

• Social services

Across a pathway of care

How do we do it?

• Share best practice

• Share innovation

• Measure and benchmark quality outcomes

• Drive and facilitate improvement

What are we doing locally around AKI?

• Completed an AKI baseline assessment – secondary care

• Forming an EoE AKI working group

1st meeting 27 May

AKI baseline assessment highlights

• 86% of providers said they were happy with the access they had to specialist renal services – normally within 24 hours.

• 76% said they had a targeted education plan for junior nurses and doctors

• 92% monitor serum creatinine regularly in adults at risk of AKI

AKI baseline assessment highlights

• 57% of the secondary care providers didn’t routinely assess for risk of AKI in surgical patients

• 71% didn’t have a system in place to routinely record the cause of the AKI, in the patients notes, to be communicated back to the GP

• 81% didn’t have any patient/carers information for the long term treatment of AKI

Members of the AKI working group

• Acute physicians

• Anaesthetists

• Surgeons

• Chemical pathologists

• Nephrologists

• Medical scientists

• Commissioners

• GPs

• Patients

Initial thoughts for AKI working group agenda

• AKI service gaps identified in the baseline assessment

• AKI transfer protocol: ITU to Renal Unit

• Review and implementation of AKI care bundle (if available

from Think Kidneys)

• National AKI CQUIN

Questions & Answer Session



Workstream requirements

What would you like from the improvement

organisations?

What can you offer in return?

14.10-14.50


Working in workstreams – 40 mins


• Having listened to the presentations from the improvement organisations

please consider what your workstream can offer those organisations and

how they can help your workstream in return.

• In your workstream group you will find two blank improvement

organisation templates that are in your workstream group – can you

consider what your workstream can offer the improvement organisations

and how the improvement organisations can help your workstream - Time

allocated for this session is 40 minutes

• Prepare 2 minutes feedback to the wider group

How can the improvement organisations help our workstream

Patient Safety Collaboratives Academic Health Science Networks Strategic Clinical Networks

Other improvement organisations

Sign up to Safety


What can our workstream offer to the improvement organisations

Patient Safety Collaboratives Academic Health Science Networks Strategic Clinical Networks

Other improvement organisations

Sign up to Safety

Workstream feedback 14.50-15.05



Role of the Commissioners

15.05-15.50



Nesta Hawker

Regional Programme of Care Manager

Internal Medicine (North)

NHS England


www.england.nhs.uk

• Commissioning - important – part of House of Care

• CCGs commission majority of pathway of AKI


www.england.nhs.uk

• Aim to test out commissioning levers e.g. CQUINS

• Access to advice and input from national experts to

develop the commissioning levers

• Southern Derby CCG testing commissioning levers in

primary and secondary care

• Reform as a Commissioner Expert Stakeholder Group

• To share best practice and develop a commissioner

toolkit for the Think Kidney website



Havering CCG


BHRUT and Havering CCG

AKI Update from Havering

130 patients per week at BHR have AKI 6800/year – figures for BHR

AKI Overview in Havering

Stage 1; 68%

Stage 2; 22%

Stage 3; 10%

0

500

1000

1500

2000

2500

3000

3500

4000

AKI and renal related acute admissions (emergency admissions only) - all ages, all providers

2013/14 2014/15M11 FOT

NHS Havering CCG N10 - Acute Tubulo-intersitial Nephritis 11 16

N13 - Obstructive Uropathy 202 198

N17 - Acute Renal Failure 1410 1793

N18 - Chronic Kidney Disease 906 815

N19 - Unspecified Kidney Failure 52 38

NHS Havering CCG Total 2581 2860

Emergency admissions Year

CCG_Name main_description 2013/14 2014/15 (Apr-Feb)

AKI Management

AKI Nurse

• Pilot run from Feb-April 2015

• Funds from National Audit Underspend

• Detection and review of all AKI Stage 2+

• E-mail co-ordination with dataset from AKI

• Alerts from pathology

• Identified basic errors in medical and nursing care

• Well received by all teams in hospital

• Full audit data available May 2015

The role of the bio-chemist and the AKI flagging

• Within secondary care AKI alerts (comments) are

reported alongside all serum creatinine results where AKI

is suspected.

• Results on patients where AKI stage 3 is suspected are

telephoned urgently by the lab to the requesting

ward/department.

• The renal team have access to a system that enables

them to view all patients where an AKI flag has been

reported.

• Cyberlab is the system used within the hospital for

viewing results.

The AKI CQUIN – implementing it locally

• Looking to roll out the primary care alert system ahead

of the April 2016 deadline

• Working on adding a description about AKI in the local

GP systems Vision and EMIS web

• Preparing GP education around system

• Adding a local incentive scheme so that secondary care

is able to cope with the changing demands of the

system

• Exploring the possibility of using a generic email

address to send the AKI flags to GP practices

Next Steps

• Ongoing AKI Nursing Practitioner

• Setting up AKI Hot Clinics

• Setting up Community Renal Resource

• Ongoing need for junior doctor and nursing education


Salford CCG


Commissioning for AKI in Salford

SPARC Salford Partnership

for Advancing Renal Care

Dr Sheila McCorkindale Diabetes and Kidney Clinical Lead Salford Clinical Commissioning Group

Dr Smeeta Sinha Renal CD Salford Royal NHS Foundation Trust

SPARC

Terms of Reference

• Optimisation of kidney care across Salford – partnership between Salford CCG, Salford Renal Department and other stakeholders

• Delivery of shared strategy

• Support the development of wider networks including GM AHSN, MAHSC, CLAHRC, CRN, Patient groups, University of Manchester and University of Salford

SPARC Membership

Not restrictive

• Clinical Lead for Diabetes and Kidney Salford CCG

• Clinical Director Renal Service, SRFT

• Service Improvement Manager NHS Salford CCG

• Renal Consultant

• Diabetes Consultant

• Open to all other stakeholders

Long Term Conditions Locally Commissioned Service

• Significant investment in Primary Care (over 2.5m per

year)

• Long Term Investment (5 Years +)

• Builds on what practices do now – developed by GP’s

• Standardisation to reduce variation (whichever practice a patient registers at)

• Operationalise the LTC strategy for primary care

• Self-care / self-management (Long Term Condition Standard)

Long Term Conditions Local Commissioned Service for Kidney

Objectives

• To develop a standardised approach for the management of Chronic Kidney Disease in Primary Care

• To prevent progression of CKD to end stage renal disease

• To raise awareness of and minimise the risk of Acute Kidney Injury (AKI)

Jointly developed kidney indicators

SPARC High quality integrated Care

AKI

Year 1 AKI reduction - Patient awareness - Pharmacy engagement

Sick day rules (1st ongoing Oct 14-Dec15)

-GMCLAHRC Academic detailing (April 14 ) IS4Ac programme Jan 15 National SC CQUIN

Year 1 AKI 2o care e-alerts

“App” (Jan 15 – April 15)

AQ 2o care & Implementation Task Group ( April 15)

Year 1 AKI transfers NORSE year 1 (2o /3o ) (Dec 14 - April 15)

Year 1 1o Care AKI e-alerts Apps to support Primary Care (April 15 - April 16)

Year 2 AKI primary care AQ bundle

Explore feasibility (Nov 14 – April 15)

Timeline

Strategy 2014 - 2016

4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6

Sick Day Rules

AKI Academic Detailing - IS4AC

Patient Stories

AKI alerts primary care development/apps/resources to support Prim Care

AKI Primary Care Bundle Development

AKI AQ Secondary Care Bundle - QI initiative (part of national pathfinder)

CKD - high risk progression research project

CKD Recognition/coding

YEAR 2014 / MONTH YEAR 2015 / MONTH YEAR 2016 - MONTH

• Ambitious strategy with multiple partners

SPARC and GMCLAHRC

AKI Sick day rules project

Phase 1 Introduction of cards as

NHS Highland Project

Phase 2 Targeted approach to

patients at high risk of AKI by

community pharmacists in

practice ( innovation funding)

AKI Care

• In partnership with Greater Manchester, Lancashire and South Cumbria SCN

• Implementation of NICE guidance

• Education

• Delivery of AKI care app www.akicare.co.uk

– In partnership with local SME

– Interest from other SCNs and trusts

– ‘Think Kidneys’ interested in accrediting

http://www.akicare.co.uk/

AKI calculator

Grades AKI 1-3

If no AKI, prompts a risk factor assessment

Highlights AKI related emergencies

• Biochemical; potassium / acid-base

• Clinical; pulmonary oedema

• Uraemic; rub / confusion / flap

Features

AKI calculator

• Grades AKI 1-3

• If no AKI, prompts a risk factor assessment

Highlights AKI related emergencies

Biochemical; potassium / acid-base

Clinical; pulmonary oedema

Uraemic; rub / confusion / flap

Provides treatment advice

AKI Care Output

Generates summary document

User can email to self and place in notes

Patient identifiers handwritten at this point

Includes completed / uncompleted actions

Upcoming Projects

AKI Academic Detailing

• Academic detailing in primary care around AKI 3 • Project supported by Salford CCG Innovation Grant • Salford PC/ SC team enrolled on Manchester Academic Health

Science Centre Improvement Science for Academics ( IS4Ac) programme.

• Working in partnership with Royal Derby Hospital/ Southern Derbyshire CCG

• Would support proposed AKI AQ bundle for primary care • Potential to mandate sessions within Salford CCG LTC LCS

2016/17 • Short paper accepted for RCGP conference Oct 2015

Upcoming Projects

AKI Care in Primary Care

• SPARC in partnership with CMFT, SME AHSN and GMCLAHRC?

• CMFT switching on AKI e-alerts for primary care

– Primary Care Guidelines developed

• SPARC working with CMFT to plan phased roll out in Salford

• Development of AKI Care app for primary care

– Interest from ‘Think Kidneys’ and other CCGs

Potential Projects

Open to partnerships

• Renal Research Fellow – AKI in secondary care

– Supported by CLAHRC

• ASSIST-CKD

– Require buy in from CMFT and LTHTR – Needs funding

• CKD-EPI creatinine and cystatin C roll out

– Innovation funding?

SUMMARY SPARC has enabled effective commissioning for AKI Joint working ensures a consistent and quality assured service across all Salford healthcare providers and enables access to innovative practice to improve clinical care. SPARC has an ambitious strategy and has developed partnerships with CLAHRC, SCN, CMFT, SME as well as other Trusts & CCGs Many thanks to everyone who has helped us We’re happy to share and collaborate so please get in touch if you think we can help you.


Southern Derbyshire CCG

Lynn Woods

Chief Nurse & Director of Quality


NHS Southern Derbyshire Clinical Commissioning Group

Southern Derbyshire CCG

AKI Commissioning

Lynn Woods

Chief Nurse & Director of Quality

https://www.thinkkidneys.nhs.uk/


Why we got involved • Commission a range of services – AKI impacts

whole pathway

• Strong drive to improve services especially patient safety

• NCEPOD report ‘Adding Insult to Injury’

• Individual commitment

• CCG Board sign up: Patient Story: Board briefings


SDCCG

• Clinically led membership organisation

• 57 local general practices (GPs) to

• Commission health services on behalf of over 525,000 patients in Southern Derbyshire.

• Vision - continuously improve the health and wellbeing of the people of Southern Derbyshire, using all resources as fairly as possible.


SDCCG

• Licensed from 1 April 2013 under provisions enacted in the Health & Social Care Act 2012, which amended the NHS Act 2006.

• CCG is Derby City, and the southern part of Derbyshire County covering Amber Valley, South Dales and South Derbyshire.


Commissioning tools

• The national standard contract for providers – community, Mental health, EMAS, acute, care homes, etc

• Contract levers & penalties consistent

• CQUIN – quality & innovation

• Consistent quality schedules

• Prescribed monitoring arrangements

• Locally Commissioned Service Framework for Primary Care


Use of commissioning levers for

AKI • Secondary care CQUIN year one almost

complete. Year 2 CQUIN agreed (to continue improvements and complement national mandated indicator)

• Primary care planning: Locally Commissioned Service Framework

(LCSF) • Baseline survey undertaken by clinical staff –

500 + GPs and Practice Nurses responded


Progress (cont)

Programme of education & awareness raising sessions Strategic Clinical Network funding (AKI/CKD) Quality Forum – PC/SC input Academic detailing – working Promoting to practices, to include all staff, GPs,

PNs/APNs, practice managers etc. delivered in range of settings

Evaluation framework – building on GP survey


Progress (cont)

Policies, Procedures & Guidelines on AKI guidelines to support care planning on discharge

Shared Care Pathology website

Sick day rules

• Information

Read codes approved


Lessons Learnt

Senior Leadership

Ambition and Innovation to improve

patient care

Bringing together a strong team who

were committed to a shared vision

Moving at pace using contractual levers


Contact Details

Lynn Woods - [email protected]

Sally Bassett - [email protected]

Nick Selby - [email protected]

Nitin Kolhe - [email protected]

mailto:[email protected]




Question & Answer Session

Facilitated by Nesta Hawker


Summary of the day

15.50-16.00

Richard Fluck

National Clinical Director (Renal)

NHS England


The clever (academic) approach Build a blender with rubber blades. Install a kitten detector The simple (implementation) approach Don’t stick a kitten in a blender Don’t press the start button if you see a kitten in the blender What you might need A chart to help you tell the difference between a kitten and food Education


Making it work

stakeholder event master slide deck final

Healthcare

think kidneys website

measurement workstream

workstream updates

smaller lims suppliers

workstream timelines

workstream requirements

workstream feedback

aki warning algorithm