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AKI and Care Homes

On Thursday 4 May, Julie Slevin, Think Kidneys Programme Development Officer spoke at the NACC conference at Haberdashers Hall in London:Raising awareness of hydration and ways to avoid Acute Kidney Injury in the care home environment

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Raising awareness of hydration
and ways to avoid Acute Kidney
Injury in the care home
environment
Thursday 4 May Haberdashers Hall, London
Julie Slevin Programme Development Officer,
Think Kidneys
Acute Kidney Injury
Acute kidney injury is a sudden and recent reduction in a person’s kidney
function. It is often referred to as AKI.
Acute kidney injury is identified by blood tests when a raised level of
creatinine shows the stage of AKI.
Acute kidney injury can be caused by a number of things such as:
Stress on the kidneys due to illness or infection
Severe dehydration
Side effects of some drugs when you are unwell
6/12/2017Acute Kidney Injury and Care Homes | 2
Key Messages
AKI is common, serious and harmful; however, you can take steps to
prevent it by understanding what it is and what you can do to reduce the
risk.
Some residents are more at risk of getting AKI. Your residents with
Diabetes/Heart failure etc are at high risk. Work with the nurse in charge
or care home owner to compile a list of which residents are at risk.
It is important that these residents drink plenty to stay well hydrated.
Keep an eye on urine output and colour and know when to report
changes to the nurse in charge or care home owner.
6/12/2017Acute Kidney Injury and Care Homes | 3
Think Kidneys in Care Home settings
Wherever you work and whatever your role in health and/or care you
should be aware of AKI. This will enable you to understand how to
reduce the risk of AKI for residents in your home.
Health and care professionals need to be well informed and proactive, to
understand who is at risk, take an active lead in prevention, learn how to
recognise AKI and help the person to recover.
Staff working in care and nursing homes can play a vital role in the early
detection, treatment and management of people who may have had an
episode of AKI or may be at risk of AKI.
6/12/2017Acute Kidney Injury and Care Homes | 4
6/12/2017Acute Kidney Injury and Care Homes | 5
Learning Outcomes
Define Acute Kidney Injury (AKI)
Discuss the possible causes of AKI
Top Tips for carers
Identify those at risk of AKI
Is Acute Kidney Injury (AKI) really a problem?
In the UK up to
100,000 deaths
each year in hospital
are associated with
acute kidney injury.
Up to 30% could
be prevented with
the right care
and treatment
28.11.2014Acute Kidney Injury and Care Homes | 6
One in five people
admitted to hospital
in the UK each year
as an emergency has
acute kidney injury
Just one in two
people know their
kidneys make urine
About 65% of acute
kidney injury starts in
the community
NCEPOD. Adding insult
to injury, 2009
Wang, et al. 2012 Ipsos MORI survey,
July 2014
Selby, et al. 2012

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AKI and Care Homes

  • 1. Raising awareness of hydration and ways to avoid Acute Kidney Injury in the care home environment Thursday 4 May Haberdashers Hall, London Julie Slevin Programme Development Officer, Think Kidneys
  • 2. Acute Kidney Injury Acute kidney injury is a sudden and recent reduction in a person’s kidney function. It is often referred to as AKI. Acute kidney injury is identified by blood tests when a raised level of creatinine shows the stage of AKI. Acute kidney injury can be caused by a number of things such as: Stress on the kidneys due to illness or infection Severe dehydration Side effects of some drugs when you are unwell 6/12/2017Acute Kidney Injury and Care Homes | 2
  • 3. Key Messages AKI is common, serious and harmful; however, you can take steps to prevent it by understanding what it is and what you can do to reduce the risk. Some residents are more at risk of getting AKI. Your residents with Diabetes/Heart failure etc are at high risk. Work with the nurse in charge or care home owner to compile a list of which residents are at risk. It is important that these residents drink plenty to stay well hydrated. Keep an eye on urine output and colour and know when to report changes to the nurse in charge or care home owner. 6/12/2017Acute Kidney Injury and Care Homes | 3
  • 4. Think Kidneys in Care Home settings Wherever you work and whatever your role in health and/or care you should be aware of AKI. This will enable you to understand how to reduce the risk of AKI for residents in your home. Health and care professionals need to be well informed and proactive, to understand who is at risk, take an active lead in prevention, learn how to recognise AKI and help the person to recover. Staff working in care and nursing homes can play a vital role in the early detection, treatment and management of people who may have had an episode of AKI or may be at risk of AKI. 6/12/2017Acute Kidney Injury and Care Homes | 4
  • 5. 6/12/2017Acute Kidney Injury and Care Homes | 5 Learning Outcomes Define Acute Kidney Injury (AKI) Discuss the possible causes of AKI Top Tips for carers Identify those at risk of AKI
  • 6. Is Acute Kidney Injury (AKI) really a problem? In the UK up to 100,000 deaths each year in hospital are associated with acute kidney injury. Up to 30% could be prevented with the right care and treatment 28.11.2014Acute Kidney Injury and Care Homes | 6 One in five people admitted to hospital in the UK each year as an emergency has acute kidney injury Just one in two people know their kidneys make urine About 65% of acute kidney injury starts in the community NCEPOD. Adding insult to injury, 2009 Wang, et al. 2012 Ipsos MORI survey, July 2014 Selby, et al. 2012
  • 7. Those aged 75 or over People with the following: Heart failure Diabetes Chronic Kidney Disease Dementia Acute illness (sickness and diarrhoea) 6/12/2017Acute Kidney Injury and Care Homes | 7 People at higher risk of AKI
  • 8. Think Kidneys public campaign 6/12/2017Acute Kidney Injury and Care Homes | 8 Find out more on the Think Kidneys Website: https://www.thinkkidneys. nhs.uk/ Watch the Think Kidneys public campaign video (3 minutes): https://www.thinkkidneys. nhs.uk/campaign/
  • 9. Causes of AKI Pre Renal (before the kidneys) Most common cause of AKI Disruption of blood flow to the kidney For example: Low blood pressure Heart Failure Low blood volume (dehydration) 6/12/2017Acute Kidney Injury and Care Homes | 9
  • 10. Causes of AKI Intrinsic (inside the kidneys) Damage to the kidney itself For example: damage to the tiny filters inside the kidneys (Glomerulonephritis) Damage to the kidney cells (Acute tubular Necrosis) 6/12/2017Acute Kidney Injury and Care Homes | 10
  • 11. Causes of AKI Post Renal (after the kidneys) Caused by a blockage in the urinary tract For example: Blocked catheter Kidney stones (renal calculi) Bladder tumours Enlarged prostate 6/12/2017Acute Kidney Injury and Care Homes | 11
  • 12. Symptoms of AKI In the early stages there may be no real symptoms or signs. A blood test is needed to detect it. However, someone with AKI can deteriorate quickly and suddenly experience any of the following: Changes to urine output, particularly a major reduction in the amount of urine passed Changes to urine colour/smell Nausea, vomiting Abdominal pains and feeling generally unwell, similar to a hangover Dehydration or thirst Confusion and drowsiness Consider urine dipstick to test for presence of blood/protein to inform GP 6/12/2017Acute Kidney Injury and Care Homes | 12
  • 13. Treatment of AKI Treatment of AKI is about identifying the cause to help you address the actions needed. Certain drugs can affect the kidneys and these include: Non-steroidal anti-inflammatory drugs (eg Ibuprofen) Drugs that lower blood pressure (eg Ramipril) Drugs used for people with diabetes (eg Metformin) Drugs used by Mental Health patients (eg Lithium) The GP may decide that some of drugs need to be stopped for a day or two The resident might need some more blood tests The GP might recommend to increase fluids or to send the resident to hospital to have some fluid replacement 6/12/2017Acute Kidney Injury and Care Homes | 13
  • 14. Preventing AKI Staff working in care and nursing homes can play a vital role in the early detection, treatment and management of people who may be at risk of AKI. The following slides show how you can do this. 6/12/2017Acute Kidney Injury and Care Homes | 14
  • 15. Tips for carers regarding the prevention of acute kidney injury Fluid balance Dehydration is the underlying cause of many common conditions including constipation, falls, urinary tract infections, pressure ulcers, malnutrition, incontinence, confusion and pre renal AKI. The elderly are more prone to dehydration because: • They may lose the ability to recognise thirst • poor mobility and incontinence may mean a person avoids drinking enough 6/12/2017Acute Kidney Injury and Care Homes | 15
  • 16. Staying hydrated Some residents may need further support to stay hydrated. For example: Choose a cup suitable for the resident – they may prefer to use a straw Support and encouragement to maintain fluid intake throughout the day It could be as simple as set drink routines rather than relying on thirst alone Jelly and other food rich in fluid can be offered to increase fluid intake if the resident doesn’t want to drink Encourage fluids when giving care at night 6/12/2017Acute Kidney Injury and Care Homes | 16 Tips for carers regarding the prevention of acute kidney injury
  • 17. Signs of dehydration Thirst Dark urine Sunken eyes Irritability Confusion Cool hands or feet Low blood pressure Raised heart rate Headaches If a person has AKI they may pass less urine than usual, or pass no urine at all 6/12/2017Acute Kidney Injury and Care Homes | 17
  • 18. Spotting dehydration This urine colour chart will give you an idea of whether a resident is drinking enough. Good means they are drinking enough and dehydrated means the body has lost water and they may need to drink more to make up for the loss. This chart could be useful although not always a reliable tool in older people because certain conditions and medications may affect urine colour 6/12/2017Acute Kidney Injury and Care Homes | 18 Tips for carers regarding the prevention of acute kidney injury
  • 19. Assessing fluid balance in residents When you start to assess fluid balance you may face some barriers. The following slides are to help to identify these barriers and suggest solutions that could be employed to overcome them 6/12/2017Acute Kidney Injury and Care Homes | 19
  • 20. Problem: The resident goes to the toilet independently and doesn’t tell the carer so it isn’t recorded on the chart. Can the residents record their own output? Explain the importance of recording it and give them a chart to complete. 6/12/2017Acute Kidney Injury and Care Homes | 20 Assessing fluid balance
  • 21. Problem The relatives give drinks to the resident so it is difficult to record how much fluid is being taken. Give the relatives a sheet with the amounts on. Get them to document the amounts of fluid input. This works for some residents too To help understand the quantities, how much fluid do you think is in these…? 6/12/2017Acute Kidney Injury and Care Homes | 21 Assessing fluid balance
  • 22. 6/12/2017Acute Kidney Injury and Care Homes | 22 Assessing Fluid Balance Standard glass = 200mls Standard Cup = 150mls Standard Jug = 1000mls
  • 23. 6/12/2017Acute Kidney Injury and Care Homes | 23 Assessing urine output Problem: The resident is incontinent of urine, making it difficult to assess how much has been passed. If weighing the sheet is an impractical proposition, (and most often it is), try estimating. Is this so impossible?
  • 24. How much urine is here? About 50 mls 6/12/2017Acute Kidney Injury and Care Homes | 24 Assessing urine output
  • 25. How much urine is here? About 200 mls 6/12/2017Acute Kidney Injury and Care Homes | 25 Assessing urine output
  • 26. How will you use this to inform you about urine output when residents are wearing pads? Do the pads used in your care setting have level indicators? 6/12/2017Acute Kidney Injury and Care Homes | 26 Assessing urine output
  • 27. Think Kidneys The kidneys don’t usually complain The kidneys can lose up to 90% of their function before you may even begin to notice The kidneys are clever organs but need a good blood supply to work effectively 6/12/2017Acute Kidney Injury and Care Homes | 27
  • 28. What can carers do to prevent Acute Kidney Injury? Think Kidneys: When assessing residents: Have they passed urine? Do they show signs of dehydration? Do they have any risk factors for AKI? If they are ill with sickness and/or diarrhoea they may need to temporarily suspend some medications Ask the nurse in charge for a visit from the GP 6/12/2017Acute Kidney Injury and Care Homes | 28
  • 29. Case study Marjory is an 83 year old resident in your care home Lived in the care home for three years after she fell at home and fractured her hip She has lost confidence in walking and likes to have assistance to walk around the home She takes ibuprofen for some pain in her hip and has tablet controlled diabetes She has some heart failure and takes Furosemide and Ramipril Do you think she is at risk of AKI? Why? 6/12/2017Acute Kidney Injury and Care Homes | 29
  • 30. Answers to Case Study Marjory is at risk of AKI: Older people are the group most at risk of AKI Older patients are especially prone to dehydration – particularly if they also have dementia or frailty, making food and fluid intake more difficult, particularly if they are reliant on others for access to fluids Patients with heart failure often have an element of Chronic Kidney Disease and are on diuretics and medicines to regulate the blood pressure Metformin (a diabetes drug) is excreted by the kidneys, and therefore raises the risk of AKI 6/12/2017Acute Kidney Injury and Care Homes | 30
  • 31. Important points about AKI AKI is common, serious and harmful; however, you can take steps to prevent it by understanding what it is and what you can do to reduce the risk. Some residents are more at risk of getting AKI. Your residents with diabetes/heart failure etc are at high risk. Work with the nurse in charge or care home owner to compile a list of which residents are at risk. It is important that these residents drink plenty to stay well hydrated. Keep an eye on urine output and colour and know when to report changes to the nurse in charge or care home owner. 6/12/2017Acute Kidney Injury and Care Homes | 31
  • 32. References Kerr M, Bedford M, Matthews B, O’Donoghue D. The economic impact of acute kidney injury in England. Nephrol Dial Transplant (2014) 29: 1362–1368. National Confidential Enquiry into Patient Outcome and Death (NCEPOD) 2009. Acute Kidney Injury: Adding Insult to Injury. National Institute for Health and Care Excellence (NICE) 2013, Clinical guideline 169, Acute Kidney Injury. Selby NM, Crowley L, Fluck RJ, McIntyre CW, Monaghan J, Lawson N, Kolhe NV. Use of electronic results reporting to diagnose and monitor AKI in hospitalized patients. Clin J Am Soc nephrol. 2012 Apr;7(4):533-40. doi: 10.2215/CJN.08970911. Epub 2012 Feb 23 Urine colour chart: http://jbfitnesssystems.com/eddie-vendetta-part-2/ Claire Stocks - Sister – Cardiac Arrest Prevention Team Darlington Memorial Hospital 6/12/2017Acute Kidney Injury and Care Homes | 32
  • 33. For further information and resources regarding Acute Kidney Injury please see the Think Kidneys website www.thinkkidneys.nhs.uk