1. Acute Kidney Injury and
Care Homes
Wessex AKI in the Community event - 24 February 2016

2. Recognition that AKI is an emerging healthcare issue
New technology and better information
Increasing number of people living longer with long term conditions
and therefore at increased risk of AKI
Need for education and improved outcomes for patients
Holistic approach – need to improve prevention, detection,
management and treatment of AKI
Two major drivers - NHS England Patient Safety Alert followed by the
Five Year Forward View
What prompted Think Kidneys? The drivers
2/28/2016Acute Kidney Injury and Care Homes Wessex | 2

3. ‘40000 excess deaths pa’ (Kerr et al April 2014)
2/28/2016Acute Kidney Injury and Care Homes Wessex | 3

4. Spring 2014
Collaboration between NHS England and the UK Renal Registry
Team of 100 experts and interested health professionals –
nephrologists, acute physicians, GPs, pharmacists, nurses etc.
Guidance for minimum care in an acute setting
Medicines Optimisation guidance
Guidance for primary care
Risk tools
Campaign for pharmacists
Working with Care Homes
Think Kidneys programme commences
2/28/2016Acute Kidney Injury and Care Homes Wessex | 4

5. 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
2/28/2016Acute Kidney Injury and Care Homes Wessex | 5

6. Think Kidneys Website
2/28/2016Acute Kidney Injury and Care Homes Wessex | 6

7. Website Resources for Primary Care
2/28/2016Acute Kidney Injury and Care Homes Wessex | 7

8. ‘Think Kidneys’ AKI Programme
| 8
2/28/2016Acute Kidney Injury and Care Homes Wessex | 8

9. 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
Acting as a portal to other areas on the website
AKI risk calculator for secondary care
AKI risk calculator for primary care
Patient leaflet
Risk workstream
2/28/2016Acute Kidney Injury and Care Homes Wessex | 9

10. 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
Risk workstream – coming next…..
2/28/2016Acute Kidney Injury and Care Homes Wessex | 10

11. 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
CPPE education campaign Autumn 2015 for pharmacists and pharmacy
technicians
Education workstream….work to date
2/28/2016Acute Kidney Injury and Care Homes Wessex | 11

12. 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
Education workstream….coming next
2/28/2016Acute Kidney Injury and Care Homes Wessex | 12

13. People don’t have a comprehensive understanding of what their kidneys
do, how to keep them healthy, or what acute kidney injury is
About half of the population don’t think their kidneys make urine, and
you’re more likely to know this if you are older
Very few people know that kidneys help in the processing of medicines
More people in the research believe that the kidneys help remove waste
from the body than thought they made urine
More people thought the kidneys made urine rather than removing
excess fluid from the body
A quarter thought that the kidneys helped control the body’s chemical
balance
2/28/2016
Findings from Ipsos MORI poll summer 2014
Acute Kidney Injury and Care Homes Wessex | 13

14. 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
Supporting primary care with guidance and tools
Focus now……
2/28/2016Acute Kidney Injury and Care Homes Wessex | 14

15. What does the offer to Primary Care consist of?
2/28/2016Acute Kidney Injury and Care Homes Wessex | 15

16. Think Kidneys in Care Home settings
Wherever you work and whatever your role in health and/or care you
should be aware of AKI. This will enable you to understand how to reduce
the risk of AKI for residents in your home.
Health and care professionals need to be well informed and proactive, to
understand who is at risk, take an active lead in prevention, learn how to
recognise AKI and help the person to recover.
Staff working in care and nursing homes can play a vital role in the early
detection, treatment and management of people who may have had an
episode of AKI or may be at risk of AKI.
2/28/2016Acute Kidney Injury and Care Homes Wessex | 16

17. Preventing acute kidney injury
Staff working in care and nursing
homes can play a vital role in the
early detection, treatment and
management of people who may be
at risk of AKI.
Think Kidneys have developed a
guide and PowerPoint slide set for
care home staff .
2/28/2016Acute Kidney Injury and Care Homes Wessex | 17

18. Tips for the prevention of acute kidney injury
Fluid balance
Dehydration is the underlying cause of many
common conditions including constipation, falls,
urinary tract infections, pressure ulcers,
malnutrition, incontinence, confusion and pre renal
AKI.
The elderly are more prone to dehydration.
• a person may lose the ability to recognise thirst.
• poor mobility and incontinence may mean a person
avoids drinking enough.
If a person has AKI they may pass less urine than
usual, or pass no urine at all.
2/28/2016Acute Kidney Injury and Care Homes Wessex | 18

19. Staying hydrated
Some residents may need further support to
stay hydrated.
For example:
Beakers instead of cups
Support and encouragement to maintain
fluid intake throughout the day
It could be as simple as set drink routines
rather than relying on thirst alone
Jelly and other fluid-rich foods can be
offered to increase fluid intake if the
resident doesn’t want to drink
2/28/2016
Tips for the prevention of acute kidney injury
Acute Kidney Injury and Care Homes Wessex | 19

20. Assessing fluid balance in residents
When you start to assess fluid
balance you may face some
barriers.
The following slides are to help
overcome these barriers.
2/28/2016Acute Kidney Injury and Care Homes Wessex | 20

21. Problem:
The resident goes to the toilet
independently and doesn’t tell
the carer so it isn’t recorded on
the chart.
Can the residents record their
own balance? Explain the
importance of recording it and
give them a chart to complete.
2/28/2016
Assessing fluid balance
Acute Kidney Injury and Care Homes Wessex | 21

22. Problem
The relatives give drinks to the
resident so it is difficult to record
how much fluid is being taken.
Give the relatives a sheet with the
amounts on. Get them to
document the amounts on fluid
balance. This works for some
residents too
To help understand the
quantities, how much fluid do you
think is in these…?
2/28/2016
Assessing fluid balance
Acute Kidney Injury and Care Homes Wessex | 22

23. 2/28/2016
Assessing Fluid Balance
Standard glass = 200mls
Standard Cup = 150mls
Standard Jug = 1000mls
Acute Kidney Injury and Care Homes Wessex | 23

24. 2/28/2016
Assessing urine output
Problem:
The resident is incontinent of
urine, making it difficult to
assess how much has been
passed.
If weighing the sheet is an
impractical proposition, (and
most often it is), try estimating.
Is this so impossible?
Acute Kidney Injury and Care Homes Wessex | 24

25. How much urine is here?
About 50 mls
2/28/2016
Assessing urine output
Acute Kidney Injury and Care Homes Wessex | 25

26. How much urine is here?
About 200 mls
2/28/2016
Assessing urine output
Acute Kidney Injury and Care Homes Wessex | 26

27. What can carers do to prevent Acute Kidney Injury?
Think Kidneys:
When assessing residents:
Have they passed urine?
Do they show signs of dehydration?
Do they have any risk factors for AKI?
If they are ill with sickness and/or
diarrhoea they may need to temporary
stop some medications
Ask the nurse in charge for a visit from the
GP
2/28/2016Acute Kidney Injury and Care Homes Wessex | 27

28. Case study
Marjory is an 83 year old resident in your
care home
Lived in the care home for three years after
she fell at home and fractured her hip
She has lost confidence in walking and likes
to have assistance to walk around the home
She takes ibuprofen for some pain in her
hip and has tablet controlled diabetes
She has some heart failure and takes
Furosemide and Ramipril
Do you think she is at risk of AKI? Why?
2/28/2016Acute Kidney Injury and Care Homes Wessex | 28

29. Answers to Case Study
Marjory is at risk of AKI:
Older people are the group most at risk of AKI
Older patients are especially prone to
dehydration – particularly if they also have
dementia or frailty, making food and fluid
intake more difficult, particularly if they are
reliant on others for access to fluids
Patients with heart failure often have an
element of Chronic Kidney Disease and are on
diuretics and medicines to regulate the blood
pressure
Metformin (a diabetes drug) is excreted by the
kidneys, and therefore raises the risk of AKI
2/28/2016Acute Kidney Injury and Care Homes Wessex | 29

30. Think Kidneys BPKA AKI leaflet
2/28/2016Acute Kidney Injury and Care Homes Wessex | 30

31. Ten minute video –
now available on the
Think Kidneys Website
https://www.thinkkid
neys.nhs.uk/aki/video
s/gptv-video/
2/28/2016
GP TV Video
Acute Kidney Injury and Care Homes Wessex | 31

32. 2/28/2016
Coming soon!
Acute Kidney Injury and Care Homes Wessex | 32
Guidance for Primary Care in
responding to the e-Alerts
Medicines Optimisation for Primary
Care
Primary Care Risk Matrix
STOP at risk of AKI cards
Register on Think Kidneys Website
for newsletter and latest
information.

33. References
References:
Kerr M, Bedford M, Matthews B, O’Donoghue D. The economic impact of acute kidney
injury in England. Nephrol Dial Transplant (2014) 29: 1362–1368.
National Confidential Enquiry into Patient Outcome and Death (NCEPOD) 2009. Acute
Kidney Injury: Adding Insult to Injury.
National Institute for Health and Care Excellence (NICE) 2013, Clinical guideline 169, Acute
Kidney Injury.
Selby NM, Crowley L, Fluck RJ, McIntyre CW, Monaghan J, Lawson N, Kolhe NV. Use of
electronic results reporting to diagnose and monitor AKI in hospitalized patients. Clin J Am
Soc nephrol. 2012 Apr;7(4):533-40. doi: 10.2215/CJN.08970911. Epub 2012 Feb 23
Urine colour chart: http://jbfitnesssystems.com/eddie-vendetta-part-2/
Claire Stocks - Sister – Cardiac Arrest Prevention Team Darlington Memorial Hospital
2/28/2016Acute Kidney Injury and Care Homes Wessex | 33

34. For further information regarding
Acute Kidney Injury please see the
Think Kidneys Website
www.thinkkidneys.nhs.uk