Dudley CCG Think Kidneys Update

Update on Think Kidneys for Dudley Clinical
Commissioning Group
Karen Thomas
Head of Programmes
UK Renal Registry
24 February 2016

What is AKI?
The size and scale of the problem
The Think Kidneys programme
Objectives
The workstreams
Where we are now
What we’ve delivered
Where next?
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Update on the Think Kidneys National Programme
Update on the Think Kidneys national programme Karen Thomas 24/2/16

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What is acute kidney injury?
Acute kidney injury (AKI) is a rapid deterioration of renal function,
resulting in inability to maintain fluid, electrolyte and acid-base
balance. It normally occurs in the context of other serious illness
(e.g. sepsis) on a background of risk.

One in five emergency admissions to hospital will have AKI
AKI is 100 times more deadly than MRSA infection
Around 20% of AKI cases are preventable
Cost of AKI to the NHS is between £434m and £620m per annum
Around 65% of AKI starts in the community
AKI is a global challenge – the NHS is the first health system to attempt
to tackle it
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The size and scale of the problem

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‘40000 excess deaths pa’ (Kerr et al April 2014)

Recognition that AKI is an emerging healthcare issue
New technology and better information
Increasing number of people living longer with long term conditions
and therefore at increased risk of AKI
Need for education and improved outcomes for patients
Holistic approach – need to improve prevention, detection,
management and treatment of AKI
Two major drivers - NHS England Patient Safety Alert followed by the
Five Year Forward View
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What prompted Think Kidneys? The drivers

Method by which NHS can rapidly alert the healthcare system to patient safety risks,
or to provide guidance on preventing harm
What are NHS patient safety alerts?
Level 3:
Directive: requires specific action(s) within timeframe
Level 2:
Specific resource and information sharing
Level 1:
Warning of emerging risk
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Alert issued 9 June 2014
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Spring 2014
Collaboration between NHS England and the UK Renal Registry
Team of 100 experts and interested health professionals –
nephrologists, acute physicians, GPs, pharmacists, nurses etc.
Working in six workstreams
Vision, strategy and objectives
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Think Kidneys programme commences

10Update on the Think Kidneys national programme Karen Thomas 24/2/16
Update on the Think Kidneys national
programme Karen Thomas
24/2/16

Ipsos MORI survey in July 2014
2006 people interviewed at home as part of an omnibus survey
Only 49% of people know that their kidneys make urine
8% thought the kidneys pumped blood
12% were aware of role in medicines processing
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Our research and part of the challenge

Think Kidneys objectives
Develop and implement tools and interventions for
prevention, detection, treatment and enhanced recovery
Promote effective management of AKI
Provide evidence-based education and training
programmes
Highlight importance of AKI to commissioners, health
care professionals and managers
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‘Think Kidneys’ AKI Programme
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Developed case studies of patients at risk of acute kidney injury
Communities at risk document published describing the communities
who are at risk of acute kidney injury
Acting as a portal to other areas on the website
AKI risk calculator for secondary care
AKI risk calculator for primary care
Patient leaflet
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Risk workstream

Develop a risk matrix – one page decision tree linked to Map of
Medicine
Develop prevention bundle / guidance for 1° and 2°care for ‘at risk’
Integration of the identification of AKI into current care planning tools
and link with Year of Care
Production of ‘stop’ card for patients
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Risk workstream – coming next…..

Identification of credible educational products that already exist
Identifying endorsement of educational products
Running events for primary care, pharmacists, care home stakeholder
Developing changes to primary care curriculum with RCGP and others
Planning public campaign to increase general knowledge of kidney
function and hydration
CPPE education campaign Autumn 2015 for pharmacists and pharmacy
technicians
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Education workstream….work to date

Discussing with GPC extending curriculum to include renal and AKI for
pharmacy
Approach nursing schools to extend curriculum to include renal and AKI
for nurses
Review primary care bundle being produced by the intervention
workstream
Identify a suitable education resource for those who have had an
episode of AKI
Develop and deliver the public campaign
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Education workstream….coming next

Visited LIMS suppliers to discuss compliance with algorithm
requirements
Responded to enquiries from the UK Renal Registry email helpline
Set up a JISCMAIL internet discussion forum - archived and monitored
discussions
Published best practice guidance document for implementing the AKI
warning algorithm - on the Think Kidneys website. Followed with ‘top
tips’ publication
Monitored the integrity of the algorithm and implementation issues on
the ground via the algorithm sub-group
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Detection workstream…..success so far

Identify potential refinement for the algorithm based on data
associated with the AKI Warning Alert
Produce secondary care case studies of implementation of the
algorithm
Working with primary care IT suppliers to ensure they can deliver the
warning stage test results
Work with Intervention workstream on how warning stage test results
trigger interruptive alerts - inform by gathering case studies
Liaise with implementation workstream to ensure appropriate
commissioning of additional laboratory and other services
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Detection workstream….coming next

Production of the secondary care bundle
Medicines management toolkit published - comprehensive advice for
prescribers on drug treatment, dose adjustment and drug withdrawal in
the context of AKI
Sick day guidance position statement
Advice on dietetic management of inpatients with AKI being created
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Intervention workstream…. work to date

Medicines management toolkit being expanded to include relevant
information for primary care
Formal literature search under way: this will be used to generate
consensus statement (BSH, BHS, RA, RCGP, others) re sick day guidance
Setting minimum standard content for discharge summary – linked to
NHS England work on discharge standards
Guidance for primary care on responding to e-alerts
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Intervention workstream…. What next?

Developed and implemented a CQUIN for secondary care. Now in
second year
Developed and implemented a local enhanced service for primary care
Working with number of CCGs to develop commissioning drivers
Development of a commissioning lever for use with care homes.
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Implementation workstream….work to date

Reformed group as commissioner expert group
Develop commissioning tools - for DGH without renal unit, care homes,
community pharmacists etc.
Development of a commissioner tool kit for the Think Kidneys website
to include
• Case studies of 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
• Map of activity with links to enable connections
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Implementation workstream….next steps

The UKRR applied for National Information Governance Board’s approval to collect
patient identifiable data for AKI patients in England
Developed final specification for the master patient index (MPI) enabling the UKRR
to identify core information about the extent of AKI in England
Ensured data transfer between Trusts and UKRR was feasible; tested data and refined
format; ensured alert and creatinine files were received by UKRR
Analysis in 3 phases –
1. Reporting of data completeness,
2. Adding of date of admission to core data set and establishing link with HES,
3. Reporting data at patient level, CCG level, Trust level including incidence, progression of AKI and
other outcomes
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Measurement workstream….work to date

Discuss with HSCIC future linkage to obtain other core data items
Link UKRR AKI dataset of RRT requirement in UK to obtain data
regarding need for RRT and non-recovery of AKI
Link with National Diabetes and CKD audit during 2016
Identify which Trusts compliant with the Patient Safety Alert, then
work with Detection to check variability and reliability of data
collected
Analyse demographic information demonstrating size of at risk
group by linking with other registries/networks
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Measurement workstream….next steps

What does the offer to Primary Care consist of?
Update on the Think Kidneys national programme Karen Thomas 24/2/16 | 26

National campaign to educate the public, patients and carers as well as
health and care professionals
Established Care Home Working Group
Raising awareness of our work across health and social care
Paediatric nephrology and mental health issues
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Focus now……

Think Kidneys is the NHS campaign to improve the care of people at risk
of, or with, acute kidney injury
AKI is common
 1 in 5 emergency admissions has AKI
 around 65% starts in the community
AKI is costly
 increasing the risk of harm and death
 it uses valuable resources
AKI is preventable and treatable
 education
 better detection
 early intervention
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Summary

Karen Thomas
Think Kidneys Programme Manager
Head of Programmes
UK Renal Registry
Karen.Thomas@renalregistry.nhs.uk
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Thank you……….Questions?
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

Dudley CCG Think Kidneys Update

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