Think Kidneys is working with the Centre for Pharmacy Postgraduate Education (CPPE) to support their acute kidney injury (AKI) learning campaign. In the UK up to 100,000 deaths each year in hospital are associated with AKI. About 65% of acute kidney injury starts in the community. Up to 30% of AKI episodes could be prevented with the right care and treatment.
The main aim of the Think Kidneys programme is to prevent the avoidable harm caused by acute kidney injury.
In Autumn 2015 CPPE will run a six week campaign, delivering a learning programme on AKI to every pharmacist and pharmacy technician in England. The intention is to encourage people to engage in the learning and to apply changes to their practice to improve patient care.
The open learning programme asks pharmacists to make a commitment to changing one thing that would improve care for those at risk of, or with, AKI.
These pledges are detailed below.
Community Pharmacy
Audit of hydration advice for patients with urinary tract infections
Each year community pharmacists are required to undertake two clinical audits as part of your contractual framework. A significant number of hospital admissions for community-acquired acute kidney injury stages 2 and 3 appear to be associated with a recent urinary tract infection (personal communication). An audit has been developed to encourage community pharmacists to target patients prescribed antibacterial medicines for a urinary tract infection, or seeking advice about urinary symptoms, with hydration messages to prevent dehydration and potential subsequent acute kidney injury. This links directly to your role in reducing admissions due to AKI. The audit has been developed by the NHS Specialist Pharmacy Services and will be available nationally via the Pharmaceutical Services Negotiating Committee (PSNC) with data collection on PharmOutcomes. As well as helping your patients, the national data collection will provide insight and evidence for community pharmacies’ contribution in this important area.
What’s the challenge?
- Commit to undertaking the audit on hydration messages for patients taking an antibacterial for a urinary tract infection or wanting advice about urinary symptoms.
- Actively engage with this and make sure that all members of your team know what is required and how to record the data accurately and completely.
If you choose this challenge, how will you make sure that you act on the audit outcomes?
The pledge
I will pledge to take part in the audit targeting all patients taking antibacterials for a urinary tract infection or wanting advice about urinary symptoms, with hydration advice.
Primary Care Pharmacy
Audit
The primary care team has access to audit data to explore the number of patients who are admitted with acute kidney injury and to investigate any impact on this following the introduction of sick day rules.
What’s the challenge?
You need to be able to identify patients who are taking medicines that increase the risk of developing renal impairment who have not had a renal check for 12 months. These medicines may include ACE inhibitors, ARBs, spironolactone, ciclosporin, tacrolimus, lithium and diuretics.
If you choose this challenge, how will you engage your colleagues in the practice so that they know what you are doing and why?
Sick day rules and primary care
You are in a good position to be able to share information and advice about the right action to take when patients are at risk of developing acute kidney injury. Also you can encourage people to seek advice from their community pharmacist, provide the sick day rules leaflet and discuss appropriate action on temporarily withholding medicines when at risk of acute kidney injury.
What’s the challenge?
You need to know:
- which of your patients are at risk of developing acute kidney injury and how to explain to them what to do and when
- which laboratory results would give you supporting information and what action it is appropriate to take.
If you choose this challenge, what approach will you take to prioritise the patients that you talk with first?
The pledge:
I will conduct an audit of patients taking one or more of the following: ACE inhibitors, ARBs, spironolactone, ciclosporin, tacrolimus, lithium and diuretics, who have not had a renal check in the last 12 months and ensure that they are given a renal check within the next three months.
Hospital Pharmacy
Medicines reconciliation
Hospital pharmacy team members are some of the key professionals involved in reconciling patient’s medicines on admission. You find out which medicines the patient is prescribed and discuss with them how and why they take them. When patients are admitted with acute kidney injury, your role is to make sure that you give the correct advice on which medicines should be prescribed and which should be withheld.
What’s the challenge?
You need to:
- recognise which medicines could put patients at risk of acute kidney injury
- talk with the patient to find out which of their medicines they take and whether they are aware of the sick day rules
- identify whether they are currently dehydrated or otherwise at risk of developing acute kidney injury
- be ready to make recommendations on withholding medicines to reduce the risk of acute kidney injury, if appropriate.
If you choose this challenge, how will you make sure that you ‘think kidneys’ for each patient you see?
The pledge:
I will ensure that I recognise the medicines which could put patients at risk of acute kidney injury, talk with each patient to find out whether they are aware of the sick day rules, identify whether they are currently dehydrated or otherwise at risk of developing acute kidney injury and be ready to make recommendations on withholding medicines to reduce the risk of acute kidney injury, if appropriate.
Alternatively, you can make a pledge of your own
The pledges can be made here.