1. Acute Kidney Injury (AKI)
Keeping kidneys healthy:
The national AKI programme
Dr Richard Fluck
richard.fluck@nhs.net,
National Clinical Director (Renal)
NHS England

2. The programme
Objectives
Think Kidneys as an improvement project
Where we are now
What we’ve delivered
Where next?
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An update on the Think Kidneys National Programme

3. ‘Think Kidneys’ AKI Programme
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4. The NHS Change model

5. 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?
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6. Measurement

7. http://www.england.nhs.uk/ourwork/patientsafety/akiprogramme/
aki-algorithm/
National Algorithm
Design – expert group
Endorsed by ACB and RA

9. Is it enough to do a test?
In conclusion, this
randomised, controlled
study did not show a
meaningful benefit of an
electronic alert system
for acute kidney injury
in patients in hospital.
The NHS campaign to improve the care of people at risk of or with, acute kidney injury | 9
Lancet 2015; 385: 1966–74

10. | 10
Detect Alert
Terminology ‘e-alerts’
Respond

11. System drivers

12. 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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14. Elements of the Safety Alert
• Standardisation of a test result based on algorithm
• Mandating
• Adoption across all NHS LIMS in England
• The Safety Alert mandates data returns
• Section 251 provides permission to UKRR
• Education
• Patient pathway
• System improvement
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15. The pathway and commissioning levers
Risk assessment
• Local CQUIN
• Enhanced service
Improved
diagnosis
• Safety alert NHS
England
Treatment
• NICE guidance
• Care bundles
Recovery
• National CQUIN
Secondary care
Primary care

16. The national CQUIN and recovery
16
Year 1
• Discharge communication
• Communication of AKI
• Need for follow up
• Medications
• Why?
• High readmission rates
• Primary care knowledge
• Future risk
• Medicines management

17. People and
Culture

18. | 18
Why is it important? ‘40000 excess deaths pa’

19. 19

20. What do they do?
Public understanding of the kidneys
IPSOS Mori poll 2014 general population
51% knew kidneys make urine
8% thought the kidneys pumped blood
12% were aware of role on medicines processing

21. Everyone's business
21.01.2015The NHS campaign to improve the care of people at risk of or with, acute kidney injury | 21

22. Five year forward view
National campaign to educate the public, patients and carers as well as
health and care professionals
Raising awareness of our work across health and social care
Working with CPPE on the autumn education campaign for pharmacists
and pharmacy technicians
Paediatric nephrology and mental health issues, established Care Home
Working Group
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Widening the net

23. Rigorous delivery & Improvement methodology

24. ‘AKI warning
stage’
Patient
management
system
Alert Response
Local systems
Message
Master
patient
index
Other data
systems
AKI
Registry
Regional
National Research
QI
Measurement

25. Spread of innovation

26. 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
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Think Kidneys highlighting exemplars

27. Patient safety collaboratives:
Academic Health Science Networks
Strategic clinical networks
Sign up for Safety
Health Foundation Project
Stakeholders
28.11.2014 | 27
The improvement bodies

28. 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 prepared for Think Kidneys website
bit.ly/TK-Sick-Day-Rules
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29. The future
Year 2
Primary and community care
Legacy
Data registry
Education packages
Information on tools
A brand and point of contact ‘Think Kidneys’
A priority for the improvement architecture
28.11.2014Acute Kidney Injury National Programme | Introducing the Think Kidneys campaign | Karen Thomas | 29

30. Summary for Think Kidneys
Tackling a common problem at a strategic level
• Deadly
• Costly
Created levers within the commissioning system
• Safety alert
• National CQUIN
Will lead on improvement
• Education and awareness
• Influenced patient safety collaboratives
• Created links with multiple stakeholders

32. Karen Thomas
Think Kidneys Programme Manager
UK Renal Registry
Karen.Thomas@renalregistry.nhs.uk
Annie Taylor
Communications Consultant to the
Acute Kidney Injury National
Programme
anniemtaylor331@gmail.com
The chairs, co-chairs and
teams of all the workstreams
in ‘Think Kidneys’
Joan Russell
Head of Patient Safety
NHS England
joan.russell@nhs.net
Ron Cullen
Director
UK Renal Registry
Ron.Cullen@renalregistry.nhs.uk
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
The NHS campaign to improve the care of people at risk of or with, acute kidney injury | 32