Patient First Conference AKI R Fluck J Russell
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Slides presented at the Patient First conference on AKI by Think Kidneys team members Richard Fluck and Joan Russell on 12th November 2015
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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 “Force multiplier” 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 ‘40000 excess deaths pa’ (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. ‘Think Kidneys’ 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
- 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
- 12. The pathway and commissioning levers | 12 Risk assessment •CQUIN in test in SDH Improved diagnosis •Safety alert NHS England Treatment •NICE guidance •Care bundles Recovery •National 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 • Discharge communication • Communication of AKI • Need for follow up • Medications Why? • High readmission rates • Primary care knowledge • Future risk • 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 ‘alerts’ Respond The NHS campaign to improve the care of people at risk of or with, acute kidney injury Patient First. PreventingHarm. ImprovingCare
- 18. ‘AKI warning stage’ Patient management system Alert Response Local systems Message Master patient index Other data systems AKI Registry Regional National Research QI Measurement
- 19. Risk Vulnerability A fixed set of characteristics – 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 – auto-regulation Diuretics – volume status ACEi/ARB and other BP targeted medications – BP and auto-regulation Metformin – 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 ‘Think Kidneys’ 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