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Acute Kidney Injury (AKI)
The Think Kidneys programmeDr Richard [email protected],Chair, Think Kidneys
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An ‘intermediate’ health stateAssociated with other serious illness
Important marker of illness severity
“Force multiplier” for poor outcomes
Potential to improve care
Reduce avoidable harm - death and morbidity
Reduce cost
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‘Think Kidneys’ AKI Programme
Who is at risk?
When do people sustain AKI?
How should patients with AKI be
managed?
What do people need to know?
13/06/2016
KDIGO Clinical Practice Guideline for Acute Kidney InjuryKidney International Supplement 2012; 2(1): 1-138
How is AKI defined?
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National Algorithm
Based in LIMS
Compares serial creatinine measures
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Improving diagnosis: using changes in serum creatinine
Laboratory definition and standardisation
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Detect Alert
Lets talk about ‘alerts’
Respond
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Care bundles http://bit.ly/27Xxn9I
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Primary Care Guidelines http://bit.ly/1TNQNqe
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Patient information http://bit.ly/1qTXKM0
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Risk http://bit.ly/1TGGphD
Risk factors
Non modifiable or fixed factorsAgeCo morbidities
Modifiable factorsDrugsExposure to new drugs and contrastVolume
TriggersSepsisHypovolaemia
Key pointsFew drugs are ‘nephrotoxic’ – avoid use of word
Most drugs are ‘situational’ in cases of AKI
1. Causative2. Adjuncts3. Altered side effect profile
Role in reducing risk of AKISick day guidance position statementhttp://bit.ly/22sGdbs
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Medicines management http://bit.ly/1TNSGTD
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Paediatric guidance http://bit.ly/1UlUPGi
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The community and care homes http://bit.ly/1TJG00K
Public awareness campaign http://bit.ly/1OViw3K
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‘AKI warning stage’
Patient management
system
Alert Response
Local systems
Message
Master patient index
Other data systems
AKI Registry
RegionalNational Research
QI
System Measurement
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Measurement http://bit.ly/1TJG00K
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Patients with a AKI alert in each region AKI rate per 1000
people
Year 1Discharge communicationCommunication of AKINeed for follow upMedications
Why?High readmission ratesPrimary care knowledgeFuture riskMedicines management
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Commissioning: national CQUIN
Key points for Quarter 3 2015/16:AKI data collection
Overall, case notes from a sample of 7,784 covering 31,136 key criteria for AKI. This is an increase of 8% since Quarter 2 (28,869 items)
A rate of 55% (17,113 items) were completed in the review of AKI discharge summaries. A 60% increase of compared to Quarter 2 (10,668 items)
All the NHS regions (London, North of England, South of England, Midlands and East of England) achieved between 51%-63% completed items (an increase in from 25%-39% in Quarter 2).
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Case studies (http://bit.ly/1X5dcmS) , examples, other work
The brand
Improvement ingredients
Data
Tools
Exemplars
Leadership
Links
NHS Improvement
NHS England
Sustainability
UK Renal Registry and funding
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Going forward – sustainability and programme future
www.thinkkidneys.nhs.uk A summary
Think Kidneys
Has delivered system levers
Providing a framework for action
Raised the profile
It is supportive of other change agents
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Karen ThomasThink Kidneys Programme ManagerUK Renal [email protected]
Annie TaylorCommunications Consultant to the Acute Kidney Injury National [email protected]
The UK Renal Registry team, chairs, co-chairs and teams of all the workstreams in ‘Think Kidneys’
Joan RussellHead of Patient SafetyNHS [email protected]
Ron CullenDirectorUK Renal [email protected]
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
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