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
29.04.2015Think 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
28.11.2014Acute 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
28.11.2014Acute 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
 One person is C and all answers related to question C are

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 East
North Cumbria
• Yorkshire and
Humber
• North West
Coast
(Hydration)
• Kent Surrey
Sussex
• Oxford
• UCL Partners
• West of
England
• South West
Peninsula
Pressure Ulcers
• Yorkshire and
Humber
• East Midlands
• West Midlands
• Eastern
• HIN South
London
• Kent Surrey
Sussex
• Oxford
Mental Health
• West of
England
• South West
Peninsula
• Kent Surrey
and Sussex
• Wessex
• Oxford
• Yorkshire and
Humber
Deteioriation
and Sepsis
• East Midlands
• North West
Coast
• West Midlands
• North East
North Cumbria
• HIN South
London
• UCL Partners
• West of
England
• Wessex
• South West
Peninsula
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
Phil.duncan@nhsiq.nhs.uk
#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

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 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 Devel
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

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

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 - lynn.woods@southernderbyshireccg.nhs.uk
Sally Bassett - sally.bassett@southernderbyshireccg.nhs.uk
Nick Selby - nick.selby@nhs.net
Nitin Kolhe - nitin.kolhe@nhs.net

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

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Stakeholder event master slide deck final