UHNM AKI Strategy & Guidelines AKI in Practice UHNM AKI Strategy & Guidelines Kate Webb Renal Advanced Pharmacist Practitioner University Hospital of North Midlands (UHNM)

Learning Objectives Hear what has been done in Local Health Economies

Summary of Presentation UHNM Strategy Goals Actions AKI Alerts UHNM Sick Day Rules

UHNM Strategy: - Goals ↓ incidence of preventable AKI + optimise pt management Implement risk assessment tools + education (1o + 2o care) Improve mortality with AKI by optimising management Optimise Drug management + timescale for ultrasound Audit

UHNM Strategy: - Actions AKI Working Party (Since 04/2013) AKI CQUIN Appointment of x2 AKI CNS Operational implications AKI alerts + WIS boards AKI CNS referrals / reviews / link registrar Education & Development Grand rounds / Virtual Academy Datix (AKI 2 + AKI 3) Sick Day Rules

AKI – Classification & Alerts AKI Stage Creatinine Criteria Urine Output Criteria Predicted Nos / year of AKI in 1000- bedded hospital One ↑ > 26mmol/l above baseline (within 48hrs) OR ↑ > 1.5 fold from baseline < 0.5ml/kg/hr for at least 6 hrs 2727 Two ↑ > 2.0 fold from baseline < 0.5ml/kg/hr for at least 12 hrs 782 Three ↑ > 3.0 fold from baseline AKI with Cr > 354mmol/l Initiation of Renal Replacement Therapy (RRT) < 0.3ml/kg/hr for at least 24 hrs Anuria > 12hrs 636 Total 4145

UK Renal Registry Data for UHNM

UHNM Sick Day Rules

Conclusion AKI can be prevented across 1o + 2o care Local strategies help to reduce ‘preventable AKI’ Long term studies will reveal how effective strategies have been at reducing mortality & morbidity

Questions