Dudley CCG Think Kidneys Update

Update on Think Kidneys for Dudley Clinical Commissioning Group

Karen ThomasHead of ProgrammesUK Renal Registry24 February 2016

What is AKI? The size and scale of the problem The Think Kidneys programme Objectives The workstreams Where we are now What we’ve delivered Where next?

| 2

Update on the Think Kidneys National Programme

Update on the Think Kidneys national programme Karen Thomas 24/2/16

| 3

What is acute kidney injury?

Acute kidney injury (AKI) is a rapid deterioration of renal function, resulting in inability to maintain fluid, electrolyte and acid-base balance. It normally occurs in the context of other serious illness (e.g. sepsis) on a background of risk.


One in five emergency admissions to hospital will have AKI AKI is 100 times more deadly than MRSA infection Around 20% of AKI cases are preventable Cost of AKI to the NHS is between £434m and £620m per annum Around 65% of AKI starts in the community AKI is a global challenge – the NHS is the first health system to attempt to tackle it

| 4

The size and scale of the problem


| 5

‘40000 excess deaths pa’ (Kerr et al April 2014)


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

| 6

What prompted Think Kidneys? The drivers


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

| 7Update on the Think Kidneys national programme Karen Thomas 24/2/16

Alert issued 9 June 2014


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. Working in six workstreams Vision, strategy and objectives

| 9

Think Kidneys programme commences


10Update on the Think Kidneys national programme Karen Thomas 24/2/16Update on the Think Kidneys national

programme Karen Thomas 24/2/16

Ipsos MORI survey in July 2014 2006 people interviewed at home as part of an omnibus survey Only 49% of people know that their kidneys make urine 8% thought the kidneys pumped blood 12% were aware of role in medicines processing

| 11

Our research and part of the challenge


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


‘Think Kidneys’ AKI Programme

| 13| 13Update on the Think Kidneys national programme Karen Thomas 24/2/16

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

| 14

Risk workstream


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 CareProduction of ‘stop’ card for patients

| 15

Risk workstream – coming next…..


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 hydrationCPPE education campaign Autumn 2015 for pharmacists and pharmacy technicians

| 16

Education workstream….work to date


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

| 17

Education workstream….coming next


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 discussionsPublished best practice guidance document for implementing the AKI warning algorithm - on the Think Kidneys website. Followed with ‘top tips’ publicationMonitored the integrity of the algorithm and implementation issues on the ground via the algorithm sub-group

| 18

Detection workstream…..success so far


Identify potential refinement for the algorithm based on data associated with the AKI Warning AlertProduce secondary care case studies of implementation of the algorithmWorking with primary care IT suppliers to ensure they can deliver the warning stage test resultsWork with Intervention workstream on how warning stage test results trigger interruptive alerts - inform by gathering case studiesLiaise with implementation workstream to ensure appropriate commissioning of additional laboratory and other services

| 19

Detection workstream….coming next


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 AKISick day guidance position statement Advice on dietetic management of inpatients with AKI being created

| 20

Intervention workstream…. work to date


Medicines management toolkit being expanded to include relevant information for primary careFormal literature search under way: this will be used to generate consensus statement (BSH, BHS, RA, RCGP, others) re sick day guidanceSetting minimum standard content for discharge summary – linked to NHS England work on discharge standardsGuidance for primary care on responding to e-alerts

| 21

Intervention workstream…. What next?


Developed and implemented a CQUIN for secondary care. Now in second yearDeveloped and implemented a local enhanced service for primary careWorking with number of CCGs to develop commissioning drivers Development of a commissioning lever for use with care homes.

| 22

Implementation workstream….work to date


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

| 23

Implementation workstream….next steps


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 EnglandEnsured data transfer between Trusts and UKRR was feasible; tested data and refined format; ensured alert and creatinine files were received by UKRRAnalysis 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

| 24

Measurement workstream….work to date


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

| 25

Measurement workstream….next steps


What does the offer to Primary Care consist of?

Update on the Think Kidneys national programme Karen Thomas 24/2/16 | 26

National campaign to educate the public, patients and carers as well as health and care professionalsEstablished Care Home Working Group Raising awareness of our work across health and social carePaediatric nephrology and mental health issues

| 27

Focus now……


Think Kidneys is the NHS campaign to improve the care of people at risk of, or with, acute kidney injury

AKI is common 1 in 5 emergency admissions has AKI around 65% starts in the community

AKI is costly increasing the risk of harm and death it uses valuable resources

AKI is preventable and treatable education better detection early intervention

| 28

Summary


Karen Thomas

Think Kidneys Programme Manager

Head of Programmes

UK Renal Registry

[email protected]

| 29

Thank you……….Questions?

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


Healthcare

Dudley CCG Think Kidneys Update