Karen Thomas, Head of Programmes at UKRR gives an update on AKI to SCNs.

1. An Update on Think Kidneys for the
Strategic Clinical Networks
Karen Thomas, Head of Programmes, UK Renal Registry
8th October 2015

2. 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
Update on the Think Kidneys national programme Karen Thomas 08/10/15 | 2

3. 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
Members of the workstream working on an AKI risk calculator for
secondary care
Members of the workstream working on an AKI risk calculator for
primary care
Patient leaflet
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Risk workstream
Update on the Think Kidneys national programme Karen Thomas 08/10/15

4. 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…..
Update on the Think Kidneys national programme Karen Thomas 08/10/15

5. 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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Education workstream….work to date
Update on the Think Kidneys national programme Karen Thomas 08/10/15

6. 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
Update on the Think Kidneys national programme Karen Thomas 08/10/15

7. 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
Update on the Think Kidneys national programme Karen Thomas 08/10/15

8. 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
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Detection workstream….coming next
Update on the Think Kidneys national programme Karen Thomas 08/10/15

9. Setting minimum standard content for discharge summary – linked to
NHS England work on discharge standards
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 rules position statement –
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Intervention workstream…. work to date
Update on the Think Kidneys national programme Karen Thomas 08/10/15

10. 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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Update on the Think Kidneys national programme Karen Thomas 08/10/15

11. As health professionals one of our key aims is to reduce the risk of
avoidable harm to our patients. Some people are at increased risk of
Acute Kidney Injury (AKI), for example those with Chronic Kidney Disease
(CKD), heart failure, or those taking particular medications (1).
Many health care professionals provide advice to such patients that
certain drugs should be temporarily discontinued during acute
intercurrent illnesses, particularly where there is disturbed fluid balance.
This advice is commonly described as ‘sick day rules’ or to take a ‘drug
holiday’.
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Sick Day Rules position statement
Update on the Think Kidneys national programme Karen Thomas 08/10/15

12. The theory
The evidence on implementation and effectiveness
Welcome comment and debate
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Sick Day Rules position statement
Update on the Think Kidneys national programme Karen Thomas 08/10/15

13. Medicines management toolkit being developed for primary care
Advice on dietetic management of inpatients with AKI being created
Formal literature search under way: this will be used to generate
consensus statement (BSH, BHS, RA, RCGP, others)
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Intervention workstream…. What next?
Update on the Think Kidneys national programme Karen Thomas 08/10/15

14. 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
Update on the Think Kidneys national programme Karen Thomas 08/10/15

15. 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
Update on the Think Kidneys national programme Karen Thomas 08/10/15

16. 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
Update on the Think Kidneys national programme Karen Thomas 08/10/15

17. 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
Update on the Think Kidneys national programme Karen Thomas 08/10/15

18. 40 laboratories routinely sending data into the UKRR
1/3 of all laboratories
Currently checking for completeness of data received
UKRR to contact all Trusts
Data on who is sending data will be published through normal UKRR
routes
Find latest info -
https://www.thinkkidneys.nhs.uk/workstreams/measurement-
workstream/full-data/
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Update on data received
Update on the Think Kidneys national programme Karen Thomas 08/10/15

19. 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
Working with CPPE on the autumn education campaign for pharmacists
and pharmacy technicians
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Focus now……
Update on the Think Kidneys national programme Karen Thomas 08/10/15

20. Karen Thomas
Think Kidneys Programme Manager
Head of Programmes
UK Renal Registry
Karen.Thomas@renalregistry.nhs.uk
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Thank you……….Questions?
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Update on the Think Kidneys national programme Karen Thomas 08/10/15