rsm aki september 2015

Acute Kidney Injury (AKI)Keeping kidneys healthy:The national AKI programmeDr Richard Fluckrichard.fluck@nhs.net,National Clinical Director (Renal)NHS England

The programme Objectives Think Kidneys as an improvement project Where we are now What we’ve delivered Where next?

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An update on the Think Kidneys National Programme

‘Think Kidneys’ AKI Programme

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The NHS Change model

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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Measurement

http://www.england.nhs.uk/ourwork/patientsafety/akiprogramme/aki-algorithm/

National AlgorithmDesign – expert group

Endorsed by ACB and RA

Is it enough to do a test?

In conclusion, this randomised, controlled study did not show a meaningful benefit of an electronic alert system for acute kidney injury in patients in hospital.

The NHS campaign to improve the care of people at risk of or with, acute kidney injury | 9

Lancet 2015; 385: 1966–74

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Detect Alert

Terminology ‘e-alerts’

Respond

System 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

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Elements of the Safety Alert

• Standardisation of a test result based on algorithm

• Mandating

• Adoption across all NHS LIMS in England

• The Safety Alert mandates data returns

• Section 251 provides permission to UKRR

• Education

• Patient pathway

• System improvement| 14

The pathway and commissioning levers

Risk assessment• Local CQUIN• Enhanced service

Improved diagnosis• Safety alert NHS

England

Treatment• NICE guidance• Care bundles

Recovery• National CQUIN

Secondary care

Primary care

The national CQUIN and recovery

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Year 1

• Discharge communication• Communication of AKI• Need for follow up• Medications

• Why?• High readmission rates• Primary care knowledge• Future risk• Medicines management

People and Culture

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Why is it important? ‘40000 excess deaths pa’

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What do they do?Public understanding of the kidneys

IPSOS Mori poll 2014 general population

51% knew kidneys make urine

8% thought the kidneys pumped blood

12% were aware of role on medicines processing

Everyone's business

21.01.2015The NHS campaign to improve the care of people at risk of or with, acute kidney injury | 21

Five year forward view National campaign to educate the public, patients and carers as well as health and care professionalsRaising awareness of our work across health and social care Working with CPPE on the autumn education campaign for pharmacists and pharmacy techniciansPaediatric nephrology and mental health issues, established Care Home Working Group

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Widening the net

Rigorous delivery & Improvement methodology

‘AKI warning stage’

Patient management

system

Alert Response

Local systems

MessageMaster patient index

Other data systems

AKI Registry

RegionalNational Research

QI

Measurement

Spread of innovation

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

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Think Kidneys highlighting exemplars

Patient safety collaboratives: Academic Health Science Networks

Strategic clinical networks

Sign up for Safety

Health Foundation Project

Stakeholders

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The improvement bodies

Sick day rules

Bristol CLAHRC undertaking formal evidence reviewPlan to use this to build consensus with other stakeholders e.g. British Hypertension Society, British Society for Heart Failure

Interim position statement prepared for Think Kidneys website

bit.ly/TK-Sick-Day-Rules

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The future

Year 2

Primary and community care

Legacy

Data registry

Education packages

Information on tools

A brand and point of contact ‘Think Kidneys’

A priority for the improvement architecture

28.11.2014Acute Kidney Injury National Programme | Introducing the Think Kidneys campaign | Karen Thomas | 29

Summary for Think Kidneys Tackling a common problem at a strategic level• Deadly• CostlyCreated levers within the commissioning system• Safety alert• National CQUINWill lead on improvement• Education and awareness• Influenced patient safety collaboratives• Created links with multiple stakeholders

Karen ThomasThink Kidneys Programme ManagerUK Renal RegistryKaren.Thomas@renalregistry.nhs.uk

Annie TaylorCommunications Consultant to the Acute Kidney Injury National Programmeanniemtaylor331@gmail.com

The chairs, co-chairs and teams of all the workstreams in ‘Think Kidneys’

Joan RussellHead of Patient SafetyNHS Englandjoan.russell@nhs.net

Ron CullenDirectorUK Renal RegistryRon.Cullen@renalregistry.nhs.uk

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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