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Patient First Conference AKI R Fluck J Russell
1. Joan Russell
Head of Patient Safety
NHS England
Dr Richard Fluck
National Clinical Director (Renal)
NHS England
Think Kidneys: The NHS campaign to improve the care of people
at risk of or with, acute kidney injury
Patient First. Preventing Harm. Improving Care
2. The NHS campaign to improve the care of people at risk of or with, acute kidney injury Patient First. PreventingHarm. ImprovingCare | 2
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.
3. 21.01.2015 | 3
Why is it important?
Associated with other serious illness
โForce multiplierโ for poor outcomes
Potential to improve care
Reduce avoidable harm - death and
morbidity
Reduce cost
Important marker of illness
The NHS campaign to improve the care of people at risk of or with, acute kidney injury Patient First. PreventingHarm. ImprovingCare
4. 21.01.2015 | 4
โ40000 excess deaths paโ (Kerr et al April 2014)
The NHS campaign to improve the care of people at risk of or with, acute kidney injury Patient First. PreventingHarm. ImprovingCare
5. It is a global healthcare issue
| 5The NHS campaign to improve the care of people at risk of or with, acute kidney injury Patient First. PreventingHarm. ImprovingCare
6. โThink Kidneysโ AKI Programme
| 6The NHS campaign to improve the care of people at risk of or with, acute kidney injury Patient First. PreventingHarm. ImprovingCare
7. Our shared purpose: reduce harm related to AKI
Who is at risk?
When do people sustain AKI?
How should patients with AKI be
managed?
What do people need to know?
| 7The NHS campaign to improve the care of people at risk of or with, acute kidney injury Patient First. PreventingHarm. ImprovingCare
8. National Algorithm
Based in LIMS
Compares serial creatinine measures
| 8The NHS campaign to improve the care of people at risk of or with, acute kidney injury Patient First. PreventingHarm. ImprovingCare
9.
10. 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
| 10The NHS campaign to improve the care of people at risk of or with, acute kidney injury Patient First. PreventingHarm. ImprovingCare
11.
12. The pathway and commissioning levers
| 12
Risk assessment
โขCQUIN in test in SDH
Improved diagnosis
โขSafety alert NHS
England
Treatment
โขNICE guidance
โขCare bundles
Recovery
โขNational CQUIN
Primary care
Secondary care
The NHS campaign to improve the care of people at risk of or with, acute kidney injury Patient First. PreventingHarm. ImprovingCare
13. Engaging with safety and improvement
partners
| 13The NHS campaign to improve the care of people at risk of or with, acute kidney injury Patient First. PreventingHarm. ImprovingCare
Patient Safety
Collaboratives
14. | 14
Influencing the System: Levers
Safety collaboratives: AHSN/SCN
Sign up for safety
Health Foundation
Forward view: into action 2015/16
NHS England is proposing to introduce new national CQUIN indicators to tackle
sepsis and acute kidney injury; and a new quality premium indicator to tackle
resistance to antibiotics.
The NHS campaign to improve the care of people at risk of or with, acute kidney injury Patient First. PreventingHarm. ImprovingCare
15. Uptake of LIMS algorithm across England to date
40 labs submitted data at least once
31.7% of accredited labs (total 123)
0
5
10
15
20
25
30
The NHS campaign to improve the care of people at risk of or with, acute kidney injury Patient First. PreventingHarm. ImprovingCare
16. The national CQUIN and recovery
Year 1
โข Discharge communication
โข Communication of AKI
โข Need for follow up
โข Medications
Why?
โข High readmission rates
โข Primary care knowledge
โข Future risk
โข Medicines management
The NHS campaign to improve the care of people at risk of or with, acute kidney injury Patient First. PreventingHarm. ImprovingCare
17. | 17
Detect Alert
Lets talk about โalertsโ
Respond
The NHS campaign to improve the care of people at risk of or with, acute kidney injury Patient First. PreventingHarm. ImprovingCare
19. Risk
Vulnerability
A fixed set of characteristics โ e.g. age, comorbidities including
CKDs, drugs
Trigger
An event that might precipitate AKI, e.g. surgery, sepsis
Response
Mitigating the risk e.g. sick days rules, monitoring
The NHS campaign to improve the care of people at risk of or with, acute kidney injury Patient First. PreventingHarm. ImprovingCare
20. The vulnerable population
Fixed factors
The elderly
The frail
Existing comorbidities
Chronic kidney disease
Previous history of acute kidney
injury
Modifiable risk factors
Drugs
NSAID โ auto-regulation
Diuretics โ volume status
ACEi/ARB and other BP
targeted medications โ
BP and auto-regulation
Metformin โ side effects
enhanced
The NHS campaign to improve the care of people at risk of or with, acute kidney injury Patient First. PreventingHarm. ImprovingCare
21. Sick day rules
The NHS campaign to improve the care of people at risk of or with, acute kidney injury Patient First. PreventingHarm. ImprovingCare
22. Summary
AKI is:
Common
1 in 5 of all emergency
admissions
2/3 starts in the community
Costly
It increases the risk of death and
harm
It costs resources
Treatable
Education
Early detection
Better intervention
The NHS campaign to improve the care of people at risk of or with, acute kidney injury Patient First. PreventingHarm. ImprovingCare
23. Karen Thomas
Think Kidneys Programme
Manager
UK Renal Registry
Karen.Thomas@renalregistry.nhs.uk
Teresa Wallace
Think Kidneys Programme
Coordinator
UK Renal Registry
Teresajane.Wallace@renalregistry.nhs.uk
Ron Cullen
Director
UK Renal Registry
Ron.Cullen@renalregistry.nhs.uk
The chairs and co-chairs of all
the workstreams in โThink
Kidneysโ
www.linkedin.com/company/think-kidneys
www.twitter.com/ThinkKidneys
www.facebook.com/thinkkidneys
www.youtube.com/user/thinkkidneys
www.slideshare.net/ThinkKidneys
www.thinkkidneys.nhs.uk
Acknowledgements
| 23The NHS campaign to improve the care of people at risk of or with, acute kidney injury Patient First. PreventingHarm. ImprovingCare
Editor's Notes
Estimated 350,000 to 750,000 cases of AKI every year
Focused on:
Who: who is at risk, vulnerable population, important triggers
When: when do people sustain AKI, how is early diagnosis supported
How: how should AKI be managed, prevention+treatment+recovery
What: what do people need to know, public patients/carers, professionals
Focused on:
Who: who is at risk, vulnerable population, important triggers
When: when do people sustain AKI, how is early diagnosis supported
How: how should AKI be managed, prevention+treatment+recovery
What: what do people need to know, public patients/carers, professionals
Focused on:
Who: who is at risk, vulnerable population, important triggers
When: when do people sustain AKI, how is early diagnosis supported
How: how should AKI be managed, prevention+treatment+recovery
What: what do people need to know, public patients/carers, professionals
How did we get here?
What does it mean?
What opportunities are there?
Raises profile of AKI and the need to develop systems to detect early and treat, provides a mechanism that hospitals with no systems or rudimentary solutions in place can use to improve
Gives laboratories a clear idea of what to demand from their LIMS suppliers
Focused on:
Who: who is at risk, vulnerable population, important triggers
When: when do people sustain AKI, how is early diagnosis supported
How: how should AKI be managed, prevention+treatment+recovery
What: what do people need to know, public patients/carers, professionals
Focused on:
Who: who is at risk, vulnerable population, important triggers
When: when do people sustain AKI, how is early diagnosis supported
How: how should AKI be managed, prevention+treatment+recovery
What: what do people need to know, public patients/carers, professionals