rsm aki september 2015
TRANSCRIPT
Acute Kidney Injury (AKI)Keeping kidneys healthy:The national AKI programmeDr Richard [email protected],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?
| 2
An update on the Think Kidneys National Programme
‘Think Kidneys’ AKI Programme
| 3| 3
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?
| 5
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
| 10
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
| 12
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
16
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
| 18
Why is it important? ‘40000 excess deaths pa’
19
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
| 22
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
| 26
Think Kidneys highlighting exemplars
Patient safety collaboratives: Academic Health Science Networks
Strategic clinical networks
Sign up for Safety
Health Foundation Project
Stakeholders
28.11.2014 | 27
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
| 28
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 [email protected]
Annie TaylorCommunications Consultant to the Acute Kidney Injury National [email protected]
The 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
The NHS campaign to improve the care of people at risk of or with, acute kidney injury | 32