Think kidneys education event 7th october master slide deck final 071014
1. Are you educating people about
Acute Kidney Injury?
Working together to share experiences and develop
education resources for the future
Education workshop| Version 0.1
7th October 2014 10.00-16.00
Prepared by the Think Kidney team
07.10.2014
2. PROGRAMME
10.00 Welcome and housekeeping
10.10 Setting the scene
• The AKI National Programme
• Why is education important to AKI?
10.25 AKI Education – maximising learning
11.00 What type of educational resources are available at the moment
12.10 Question Time Panel
12.30 Soapbox – an opportunity for delegates to present their
resources
13.00 Lunch
13.45 Group Work in your clinical perspective
14.55 Feedback from Group Work
15.10 Using social media to reach a wide range of stakeholders
15.40 Closing remarks and next steps
16.00 Close
3. Setting the scene
10.10 – 10.25
The AKI National Programme and why
education is important to AKI?
Mike Jones
Acute Physician
Royal College of Physicians
5. • It is estimated that 1 in 5 emergency admissions
into hospital are associated with AKI (Wang et al,
2012)
• Up to 100,000 deaths in secondary care are
associated with AKI and 1/4 to 1/3 have the
potential to be prevented (National Confidential
Enquiry into Patient Outcome and Death
(NCEPOD) Adding Insult to Injury 2009)
• Not a specialty specific issue - the majority of
cases arise and/or are managed in the community
or across all specialities within secondary care
(Selby et al, 2012).
Acute Kidney Injury
8. ”One in five emergency admissions to hospital will have
AKI”
"AKI is 100 times more deadly than MRSA infection”
”Around 20 per cent of AKI cases are preventable”
”costs of AKI to the NHS are £434-620m pa”
9. ‘reducing avoidable death, long-term disability and
chronic ill health…’
•VTE prevention: estimate 25,000 deaths pa
Data derived from: Hospital Episode Statistics Annual Report
DoH VTE Prevention Programme 2010 and Selby et al 2012
10. Incidence of AKI is increasing
Hsu CY et al. Kidney International (2007) 72, 208
* Per 100,000 person years
Hsu RK et al. JASN 2013;24:37-42
* Per million person years
AKI not requiring dialysis Dialysis-requiring AKI
11. Patients with AKI do not die from
uraemia
41.1%
19.2%
12.9%
17.1%
6.6%
3.1%
Selby NM et al. PLoS ONE 2012; 7(11):
12. Bi-directional relationship of AKI and CKD
Ishani A et al. JASN 2009; 20: 223–228
233,803 hospitalised patients aged over
67
AKI increased risk of ESKD by 13 fold
Baseline renal
function
Rate ratio for
hospital admission
with AKI*
eGFR >60 1.0
eGFR 45-59.9 2.3
eGFR 30-44.9 5.6
eGFR 15-29.9 13
*non-proteinuric group shown; similar pattern seen across all
levels of proteinuria
James MT et al. Lancet 2010; 376: 2096-2103
1million patients with baseline assessments
of serum creatinine and proteinuria
CKD and proteinuria increase risk of AKI
13. NCEPOD report published in 2009
Poor assessment of risk
factors for AKI and acute
illness
Delays in recognising AKI
Most patients with AKI are
not cared for by
nephrologists
Post admission AKI
avoidable in 21%
‘Good’ care in <50% cases
14. Key findings
Only 50% of AKI care considered good
Poor assessment of risk factors
Unacceptable delay in recognition of
post-admission in AKI in 43%
22 patients died with a primary
diagnosis of post-admission AKI which
was predictable and avoidable
Complications missed (13%),
avoidable (17%) or badly managed
(22%)
15. Conclusion
Systematic failings in AKI
Failures in:
Recognition and management of AKI
Recognition and management of
complications
Referral and support
Failures in recognition of the acutely ill
16. Primary Aim
The primary aim of the National
Programme is to ensure avoidable
harm related to AKI is prevented
in all care settings.
17. The purpose of the National Programme is to deliver and
implement a structure and tools within three years that will
lead to a fall in the number of preventable episodes of AKI,
and with that a reduction in deaths associated with AKI.
It will lead work on the development of clinical tools,
information and levers and prioritise patient empowerment.
It will utilise commissioning pathways and other clinical
networks.
It will also establish local and national data collection and
audit leading to further safety improvement and target
research towards areas that require elucidation.
Programme Purpose
18. The primary aim of the National Programme is to ensure avoidable harm
related to AKI is prevented in all care settings. It will aim to do this by:
• Ensuring that a variety of tools and interventions are developed and
implemented to support the prevention, early detection, treatment
and enhanced recovery of patients with AKI.
• Ensuring that patients who develop AKI are appropriately managed to
reduce further deterioration, long term disability and death.
• Ensuring that appropriate education and training programmes are
developed for all health professionals based on best available
evidence.
• Ensuring that commissioners, health care professionals and managers
are aware of the importance and risks of AKI and appropriate local
strategies to reduce the burden of AKI are developed.
Programme Objectives
19. • Developing a national registry and audit for AKI leading to an
improvement strategy on a national and local basis to reduce
unwarranted variation in care.
• Involving patients and the public in understanding the risk of AKI and
preventative measures through education and appropriate access to
personal information.
• Supporting the development of a commissioning structure to allow
local service configuration to provide quality care to individuals with
AKI.
• Identifying the research agenda for AKI (including basic science, clinical
care and service delivery).
Programme Objectives continued
20. WellGroup
Acute Kidney Injury Patient
Pathway
AKI National Programme
AtRiskGroup
Diagnosis
Treatment
Recovery
AtRisk+Event
21. Education Workstream
Formalised Education Publicity Campaign
Core Education Workstream Group
Michael Jones Michael Wise Cat Shaw Nicky Wood
Michelle Timoney Chris Laing Sue Shaw Kathryn Griffith
Claire Scott Karen Thomas Winnie Wade Martin Christian
Pauline Pinkos
22. AKI Education – maximising learning
10.25 – 11.00
Winnie Wade
Director of Education
Royal College of Physicians
23. Winnie Wade and David Parry
Royal College of Physicians
AKI Education -
maximising learning
October 2014
24. Objectives
• Identify factors that affect learning
• Recognise the significance of different
learning styles
• Identify different modes of learning
• Consider the challenges in designing
educational programmes
• Propose solutions to maximise
learning
33. Change in role
Teacher as Expert Teacher as Facilitator
Teaching objectives Learning objectives
Telling Listening
Discourage participation Encourage participation
Ask fewer questions Ask a lot of questions
No feedback Constructive feedback
34. Some people prefer to take in information through:
DOING PICTURES WORDS
CONCRETE ABSTRACT
Learning styles
37. The Educational Cycle
• Assessing the individual’s needs
• Setting educational objectives
• Choosing and using a variety of
methods of teaching and learning
• Assessing that learning has occurred
39. Strengths of learning about AKI
on-the-job
• Rich in context and clinical content
• Often 1:1, so more tailored teaching
• Opportunities for active learning,
feedback and role modelling
• Good place to learn clinical skills and
clinical reasoning
• Context of learning matches context
for future practice
40. Maximising Learning
• Recognise individual learning needs
• Encourage autonomy in learning
• Create a safe, supportive learning
environment
• Encourage self-reflection
• Provide a variety of modes of learning
Train the teachers
42. What type of educational resources
are available at the moment
11.00 – 12.10
AKI: a national learning programme for pharmacy- Sue Shaw,
Advanced Renal Services Pharmacist, Royal Derby Hospitals NHS
Foundation Trust
Engaging health care professionals using electronic learning
resources – Gang Xu, Senior Nephrology Trainee, East Midlands
Deanery
Apps for Education, - Ben Bray, Quality Improvement Fellow,
King's College London
NICE AKI online learning for nurses and healthcare support
workers – Elaine Whitby, Associate Director – Education and
Support, NICE
How Can We Translate Improved Education on AKI into Better
Care For Patients? – Andy Lewington, Consultant Renal
Physician/Honorary Clinical Associate Professor, Director of
Undergraduate Medical Education Leeds Teaching Hospitals Trust
43. What type of educational resources
are available at the moment
11.00 – 12.10
AKI: a national learning programme for
pharmacy
Sue Shaw
Advanced Renal Services Pharmacist
Royal Derby Hospitals NHS Foundation Trust
44. Dr Sue Shaw
Advanced Renal
Services Pharmacist,
Royal Derby Hospital
Adrian Coleman, Caroline Ashley,
Claire Morlidge, Emily Horwill, Rania
Betmouni, Renal Pharmacists.
Nick Selby,
Consultant Nephrologist.
49. 2. Case discussions (Medicines
optimisation in AKI, Contrast-induced
nephropathy, ‘Sick Day Rules’)
50. Case Three:
• Pankaj Gupta is a 76-year-old male with stage
3 CKD and hypertension. He has presented to
A&E after being unwell with diarrhoea and
vomiting for more than 24 hours.
• DHx: Bendroflumethiazide 2.5mg OM
Ramipril 10mg ON
Simvastatin 40mg ON
Trimethoprim 200mg BD (UTI)
51. • Good uptake of the programme including at
national pharmacy events
• Linked to national Medicines Optimisation Toolkit
produced by the UK Renal Pharmacy Group
• Supports the Royal Pharmaceutical Society work
for community pharmacists regarding ‘Sick Day’
rules and local CQuin pathfinder project
52. What type of educational resources
are available at the moment
11.00 – 12.10
Engaging health care professionals using
electronic learning resources
Gang Xu, Senior Nephrology Trainee, East
Midlands Deanery
53. +
Engaging health
care professional
using electronic
learning
resources…
Improving Outcomes in Acute Kidney Injury
(AKI)through education.
G Xu, R Westacott, R Baines, N Selby, S Carr.
65. +
Lectures / Small group session:
Integrated into established “protected” teaching sessions (Program
expanded)
Grand round / department meetings.
66. +
Measure the changes:
Using TurningPoint software collected data on knowledge
and confidence of clinicians when treating patients with AKI.
Before and after the educational package was developed and
deployed.
71. +
Still much to be done….
Low number of doctors used the e-learning tool
However higher than expected uptake from other health care
professionals.
Post intervention number of patients with AKI having
documented urine-dip:
72. +
Summary:
Better education needed still…
Electronic resources is a potentially powerful tool
Engagement remains the key
Traditional teaching still has a firm place.
74. What type of educational resources
are available at the moment
11.00 – 12.10
Apps for Education
Ben Bray
Quality Improvement Fellow
King's College London
76. Outline
• Funded by NHS Kidney Care
• Produced & owned by RCP Edinburgh
• Content written by clinicians
• Clinical content approved by Renal Association,
RCP Edinburgh & Society of Acute Medicine
• Free for users
• Launched June 2013
• Technical update Sep 2014
85. Global reach
0 10 20 30 40 50 60
Europe
Asia
North America
South America
Middle East
Central America
Africa
Oceania
% active users
86. 0 10 20 30 40 50
iPhone
iPad
Android Phone
Android Tablet
% active users
vs
87. Learning points
− Expensive & time consuming
− Relationship with developers v important
− Needs commitment to update and maintain
+ Wide reach
+ Democratic & accessible
+ Usage analytics
88. Download
• Search “AKI app” for RCPE app on iTunes store
or Google Play store
• Search “London AKI app” for London AKI app
on iTunes store
More info:
b.jackson@rcpe.ac.uk [Bryony Jackson]
Me: benjamin.bray@kcl.ac.uk
89. What type of educational resources
are available at the moment
11.00 – 12.10
NICE AKI online learning for nurses and
healthcare support workers
Elaine Whitby
Associate Director – Education and Support
NICE
90. NICE AKI online learning for nurses and
healthcare support workers
Elaine Whitby
Oct 2014
91. Page No. | Date
NICE guidance & e-learning
• August 2013 NICE guideline published: Acute kidney
injury: prevention, detection and management of acute
kidney injury up to the point of renal replacement therapy
• Search for existing e-learning: programmes or modules
for doctors or pharmacists, nil specific to nursing
• Recognition - nurses & healthcare support workers
crucial to identifying risk and early detection
• NICE commissioned e-learning resource
• Published March 2014
92. Page No. | Date
Aim & objectives
Audience
• Nurses and healthcare support workers
Aim
• The aim of this learning programme is to support nurses and healthcare support workers in all
settings in preventing and identifying AKI.
Learning outcomes for nurses:
• Define AKI
• Recognise and assess patients at risk of AKI
• Recognise and assess signs and symptoms of AKI
• Escalate patients with AKI risk factors, signs or symptoms to medical staff or advanced nurse
practitioner (ANP)
• Support the multidisciplinary team in the management of a patient with AKI in primary or
secondary care
• Support patients and carers throughout the course of their illness and afterwards
Learning outcomes for healthcare support workers:
• Contribute to the assessment of patients at risk of AKI
• Report results to the nurse or doctor responsible for the patient’s care
• Escalate any result that shows positive for blood or protein
• Calculate and record an early warning system (EWS) tracker and urine output (U/O).
• Record and escalate an abnormal EWS tracker or abnormal U/O
93. Page No. | Date
5 Sections:
• What is AKI and who is at risk?
• How do we recognise and prevent AKI?
• How do we manage AKI?
• How do we support patients and carers?
• Clinical case study
Nurses - all sections
HSWs - section 2
Structure
98. Page No. | Date
The story so far
• 1st NICE online learning specifically for nurses
• Evaluation: 669 people enrolled
Qualitative feedback:
• ‘I found the tool extremely useful’
• ‘Great learning resource’
• ‘It was helpful to be able to judge my level of understanding
as I worked through the units’.
• ‘The presentation is interactive and memorable ….flowed
well making it easy to work through’
Problems:
• Monitoring completion
• Obtaining certificates
99. Page No. | Date
Next steps
Addressing technical issues
Increasing feedback
Widening access: discussions with e-learning for healthcare (e-LfH) to
host the module
Tool access: http://www.nice.org.uk/guidance/cg169/resources
100. What type of educational resources
are available at the moment
11.00 – 12.10
How Can We Translate Improved Education on
AKI into Better Care For Patients?
Andy Lewington, Consultant Renal Physician /
Honorary Clinical Associate Professor, Director of
Undergraduate Medical Education Leeds
Teaching Hospitals Trust
101. Acute Kidney Injury: What Taught
Programmes Are Available?
Dr AJP Lewington
Consultant Renal Physician/Honorary Associate Professor
Director of Undergraduate Medical Education
Leeds Teaching Hospitals
102. Declaration of Interest
• AbbVie – Advisory Board for Melanocortin
therapy for AKI, Honoraria for Lectures
• AM Pharma – Advisory Board and Co Chief
Investigator for Alkaline Phosphatase therapy for
AKI
• Alere – Honoraria for chairing meeting
• Bioporto – Advisory Board for NGAL
• Fresenius – Honoraria for lecture at ICS
• Baxter – Honoraria for lecturing on IV Fluids
104. Levers
• NCEPOD
– Adding Insult to Injury 2009
• NICE
– AKI CG 169 2013
– AKI Quality Standard 2014
– IV Fluids CG 174 2013
• NHS England
– AKI warning March 2015
108. Undergraduate Medicine
• Identify where renal medicine is taught in
the curriculum and what is covered
– University of Leeds
• 1st Yr – Body Systems
– 10 lectures/3 seminars
• 2nd, 3rd and 5th Yr clinical placements
• RRAPID simulation course
– scenarios with patients developing sepsis, hypovolaemia
and AKI
• Assessment – written and OSCEs
109. Recognising And Responding To Acute
Patient Illness And Deterioration
ALT Conference 2014, Warwick
S. Bickerdike, L. Smith, A. Dean,
I. Kozieradzka-Ogunmakin, A. Lewington
117. Primary Care
• Renal Medicine?
• Building a case
• secondary care placements in Renal
Medicine - Leeds
• Target Teaching Days
– Make it relevant
– Link CKD and AKI
– with a GP
– cases
118. Challenge
Make AKI the remit of ALL GP’s
and General medicine teams
• The greater the number of risk factors an
individual patient has for AKI the greater the
likelihood of AKI being present on admission.
• About 50% of acute medical patients are
taking nephrotoxic medication prior to
admission
119. Secondary Care
• Local postgraduate programmes
– FY, CMT, StRs, Grand Rounds
– Departmental
• National programmes
– CCrISP – Care of the Critically Ill Surgical
Patients – Royal College of Surgeons
– IMPACT
120. Conferences - UK
• Royal Society of Medicine
– AKI Frontiers – 26 Sept 2014
• Royal College of Physicians - London
– 28 Oct 2014 – AKI Update
• Renal Association/EDTA - London
– 28/31 May 2015
• British Renal Society
• Royal Free/UCL
– AKI Academy – 18/19 Oct 2014
121. Conferences - UK
• Yorkshire & Humber AKI Patient Care
Initiative (AKIPCI) – Wakefield
– 17 October 2014
• STOP AKI Study Day – Leeds
– 6 November 2014
• Leeds 2nd Critical Care Nephrology
Conference
– 19 May 2015
122. Conferences - International
• CRRT – San Diego
– 17-20 Feb 2015
• International Society of Nephrology –
Cape Town
– 13-16 March 2015
• Need an AKI conference calender on AKI
website
123. Summary
• Need to develop Educational strategy
– covers undergraduate and postgraduate training
• curriculum
• organic
– multiprofessional/interprofessional
– interesting
• link in with sepsis, fluids etc
• link with national programmes
– assessed
– sustainable
125. Question Time Panel
12.10 – 12.30
Panel Members
Sue Shaw, Advanced Renal Services Pharmacist, Royal
Derby Hospitals NHS Foundation Trust
Gang Xu, Senior Nephrology Trainee, East Midlands
Deanery
Ben Bray, Quality Improvement Fellow, King's College
London
Elaine Whitby, Associate Director – Education and
Support, NICE
Andy Lewington, Consultant Renal Physician/Honorary
Clinical Associate Professor, Director of Undergraduate
Medical Education Leeds Teaching Hospitals Trust
126. Soap Box Session
12.10 – 12.30
An opportunity for delegates to present their
resources in a rapid fire session where each
presenter will be allowed 2 minutes to present
their resource
Kathryn Griffith
General Practitioner
Royal College of General Practitioners
127. Reverse Brainstorming
How to Damage Marjory’s Kidneys
Kathryn E Griffith
Clinical Champion for Kidney Care
Royal College of General Practitioners
128. Causes of AKI
Exposures Susceptibilities
Sepsis Dehydration or volume depletion
Critical illness Advanced age
Circulatory shock Female gender
Burns Black race
Trauma CKD
Cardiac surgery especially
bypass
Chronic heart, lung or liver
disease
Major surgery Diabetes mellitus
Nephrotoxic drugs Cancer
Radiocontrast agents Anaemia
Poisonous plants and animals
129. Marjory Aged 88 Group1
• Marjory lives
alone and enjoys
life
• What can she do
to damage her
kidneys?
130. How to Damage Marjory’s Kidneys
Group 1: Age 88 what can she do?
Group 2: BP 170/90 what can you do?
Group 3: Dysuria and frequency what can
you do?
Group 4: AMI What can the Cardiologist do?
Group 5: Heart Failure ramipril and
eplerenone what can you do?
131. Potential causes of AKI
Exposures Susceptibilities
Sepsis Dehydration or volume depletion
Critical illness Advanced age
Circulatory shock Female gender
Burns Black race
Trauma CKD
Cardiac surgery especially
bypass
Chronic heart, lung or liver
disease
Major surgery Diabetes mellitus
Nephrotoxic drugs Cancer
Radiocontrast agents Anaemia
Poisonous plants and animals Care of Cardiolgist !!
133. AKI (NH6179) module
Ferdinand Bravo
(Ferdinand.Bravo@bsuh.nhs.uk)
Renal pathway – Module leader
Sussex Kidney Unit/University of Brighton
134. AKI (NH6179) module
• 20 credit, level 6 (degree level) post graduate
nursing module.
• Part of renal pathway course.
• Can be taken as a stand alone module or part to
complete
• Acute care in professional practice (BSc-hons) or
Post graduate in acute care in professional
practice.
135. AKI (NH6179) module
Pre-requisite:
• Applicable to health care professionals in
all areas of care with at least one year’s
experience in practice.
136. AKI (NH6179) module
Brief description of module content:
• This module will enable the student to
develop understanding of AKI disease
process and critically explore the
preventive and therapeutic management
within the sphere of practice.
137. AKI (NH6179) module
Teaching and Assessment:
• Blended learning
• Case presentation/PBL
• OSCE – assessment of renal functions
• 2500 word case study on AKI management with
focus on prevention.
139. Group Work in your clinical
perspective
13.45 - 14.55
Instructions
We have set a series of questions for each of the 5 groups
to answer. The questions can be found in your group.
Your name badge has the number of your group on it to
indicate which group you should go to. A facilitator will
be in your group to guide you through the process and to
ensure you prepare a 2 minute highlight presentation to
feedback to the whole group. You will find templates and
pens in your groups.
You have 1 hour and 10 minutes allocated for this group
work.
140. Group Work
• Group 1 – Facilitator Mike Jones
• Group 2 – Facilitator Peter Hewins
• Group 3 – Facilitator Claire Stocks
• Group 4 – Facilitator Elaine Whitby
• Group 5 – Facilitators Annie Taylor/Richard Hull
• Group 6 – Facilitator Kathryn Griffith
141. Group Work QuestionsGroups 1-4 Group 5 Group 6
What educational resources are
missing for our profession in respect
of AKI?
What educational resources are
missing for health and care
professionals in respect of AKI?
What educational resources are missing
for our profession in respect of AKI?
What is the best medium for
education in our profession? What
resources are required?
What is the best medium for
education about AKI across the
NHS?
What is the best medium for education in
our profession? What resources are
required?
Where do you think education is
most needed? Which groups should
we target for the most impact?
Where do you think education is
most needed? Which groups should
we target for the most impact?
Where do you think education is most
needed? Which groups should we target
for the most impact?
What are the main impediments to
training for our profession?
What are the main impediments to
training for improvement agents,
managers and others (non-
clinicians) in the NHS?
What are the main impediments to
training for our profession?
How can the AKI National
Programme help the professionals
in your locality?
How can the AKI National
Programme help you and your
professional colleagues learn about
AKI?
How can the AKI National Programme
help the professionals in your locality?
What material currently exists to help
GPs explain AKI and risk to patients, how
useful is it and what else is needed?
From the patient’s perspective what
information is needed and in what
format?
142. Feedback from Group Work
14.55 – 15.10
• 2 minutes feedback from each group
143. Using social media to reach a wide
range of stakeholders
15.10 – 15.40
Amy Burton
Social Media Executive
Diabetes UK
144. Closing remarks and next steps
15.40 – 16.00
Mike Jones
Acute Physician
Royal College of Physicians
145. How to find out more
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
28.11.2014Acute Kidney Injury National Programme | Introducing the Think Kidneys campaign | Karen Thomas |
145
Contact Think Kidneys
Richard Fluck
National Clinical Director for Renal
NHS England
Richard.fluck@nhs.net
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
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www.thinkkidneys.nhs.uk