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Joan Russell Head of Patient Safety NHS EnglandDr Richard Fluck National Clinical Director (Renal)NHS England
Think Kidneys: The NHS campaign to improve the care of people at risk of or with, acute kidney injury
Patient First. Preventing Harm. Improving Care
The NHS campaign to improve the care of people at risk of or with, acute kidney injury Patient First. Preventing Harm. Improving Care | 2
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.
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Why is it important?Associated with other serious illness
“Force multiplier” for poor outcomes
Potential to improve care
Reduce avoidable harm - death and morbidity
Reduce cost
Important marker of illness
The NHS campaign to improve the care of people at risk of or with, acute kidney injury Patient First. Preventing Harm. Improving Care
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‘40000 excess deaths pa’ (Kerr et al April 2014)
The NHS campaign to improve the care of people at risk of or with, acute kidney injury Patient First. Preventing Harm. Improving Care
It is a global healthcare issue
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‘Think Kidneys’ AKI Programme
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Our shared purpose: reduce harm related to AKI
Who is at risk?
When do people sustain AKI?
How should patients with AKI be
managed?
What do people need to know?
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National Algorithm
Based in LIMS
Compares serial creatinine measures
| 8The NHS campaign to improve the care of people at risk of or with, acute kidney injury Patient First. Preventing Harm. Improving Care
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
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The pathway and commissioning levers
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Risk assessment• CQUIN in
test in SDH
Improved diagnosis• Safety alert
NHS England
Treatment• NICE
guidance• Care bundles
Recovery• National
CQUIN
Primary care
Secondary care
The NHS campaign to improve the care of people at risk of or with, acute kidney injury Patient First. Preventing Harm. Improving Care
Engaging with safety and improvement partners
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Patient Safety Collaboratives
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Influencing the System: Levers
Safety collaboratives: AHSN/SCNSign up for safetyHealth Foundation
Forward view: into action 2015/16NHS England is proposing to introduce new national CQUIN indicators to tackle sepsis and acute kidney injury; and a new quality premium indicator to tackle resistance to antibiotics.
The NHS campaign to improve the care of people at risk of or with, acute kidney injury Patient First. Preventing Harm. Improving Care
Uptake of LIMS algorithm across England to date
40 labs submitted data at least once
31.7% of accredited labs (total 123)
April May JuneJuly
August
Septem
ber05
1015202530
The NHS campaign to improve the care of people at risk of or with, acute kidney injury Patient First. Preventing Harm. Improving Care
The national CQUIN and recoveryYear 1• Discharge communication• Communication of AKI• Need for follow up• Medications
Why?• High readmission rates• Primary care knowledge• Future risk• Medicines management
The NHS campaign to improve the care of people at risk of or with, acute kidney injury Patient First. Preventing Harm. Improving Care
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Detect Alert
Lets talk about ‘alerts’
Respond
The NHS campaign to improve the care of people at risk of or with, acute kidney injury Patient First. Preventing Harm. Improving Care
‘AKI warning stage’
Patient management
system
Alert Response
Local systems
MessageMaster patient index
Other data systems
AKI Registry
RegionalNational Research
QI
Measurement
RiskVulnerability
A fixed set of characteristics – e.g. age, comorbidities including CKDs, drugs
TriggerAn event that might precipitate AKI, e.g. surgery, sepsis
ResponseMitigating the risk e.g. sick days rules, monitoring
The NHS campaign to improve the care of people at risk of or with, acute kidney injury Patient First. Preventing Harm. Improving Care
The vulnerable populationFixed factors
The elderlyThe frailExisting comorbiditiesChronic kidney diseasePrevious history of acute kidney injury
Modifiable risk factors
DrugsNSAID – auto-regulationDiuretics – volume statusACEi/ARB and other BP targeted medications – BP and auto-regulationMetformin – side effects enhanced
The NHS campaign to improve the care of people at risk of or with, acute kidney injury Patient First. Preventing Harm. Improving Care
Sick day rules
The NHS campaign to improve the care of people at risk of or with, acute kidney injury Patient First. Preventing Harm. Improving Care
SummaryAKI is:
Common1 in 5 of all emergency
admissions2/3 starts in the community
CostlyIt increases the risk of death and harmIt costs resources
TreatableEducationEarly detectionBetter intervention
The NHS campaign to improve the care of people at risk of or with, acute kidney injury Patient First. Preventing Harm. Improving Care
Karen ThomasThink Kidneys Programme ManagerUK Renal [email protected]
Teresa WallaceThink Kidneys Programme CoordinatorUK Renal [email protected]
Ron CullenDirectorUK Renal [email protected]
The chairs and co-chairs of all the workstreams in ‘Think Kidneys’
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
| 23The NHS campaign to improve the care of people at risk of or with, acute kidney injury Patient First. Preventing Harm. Improving Care
