Claire Oates Renal pharmacist North Bristol NHS Trust

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Presentation transcript:

Claire Oates Renal pharmacist North Bristol NHS Trust Acute Kidney Injury Claire Oates Renal pharmacist North Bristol NHS Trust

Objectives Local pharmacy initiatives Prescribing patterns in AKI AKI alerts 3 days experience ! Meeting the CQUIN targets - pharmacy challenges Sick day rules cards good or bad ?

Local training AKI “top tips” for pharmacists AKI mentoring visits – every 3 years Lunch time teaching sessions AKI medicines optimisation checklist Antibiotic dosing guidelines

Prescribing patterns in AKI No local audit data BRS 2015 McManus – Antrim Area Hospital Northern Ireland Analysed 1197AKI e-alerts over a six week period 456 unique non-dialysis patients were identified Higher AKIN stage appeared to associate with diuretic prescription and nursing home residence Medication prescribed at time of AKI e-alert AKIN1 AKIN2 AKIN3 One or more of ACEI/ARB/diuretic/NSAID 201(57.3%) 43 (60%) 21 (55%) Diuretic alone 64 (18%) 17 (24%) 12 (31%) ACEI/ARB alone 35 (10%) 8 (11%) 1 (3%) ACEI/ARB + diuretic 77 (21.5%) 16 (23%) 8 (21%) NSAID alone 16 (4.5%) 1 (1%) NSAID + ACEI/ARB 4 (1%) NSAID + diuretic NSAID + ACEI/ARB + diuretic 1 (0.3%)

AKI eAlerts 3 days experience Great opportunity to prioritise sick patients Baseline data: N=24 Level 1 - 16 (2 ?false alerts) Level 2 - 1 Level 3 - 4 Dialysis - 3 Poor completion of AKI risk assessment on admission N=19 Yes = 9, No=6, Partly =4 Drug charts don’t include details of eGFR / AKI N= 16 AKI on chart Yes=0 No=16 N= 16 eGFR on chart Yes=8, No =5, Out of date =3 2 Interventions made relating to LMWH doses

CQUIN targets The percentage of patients with AKI treated in an acute hospital whose discharge summary includes each of four key items: 1. Stage of AKI (a key aspect of AKI diagnosis); 2. Evidence of medicines review having been undertaken (a key aspect of AKI treatment) 3. Type of blood tests required on discharge; for monitoring (a key aspect of post discharge care); 4. Frequency of blood tests required on discharge for monitoring (a key aspect of post discharge care).

Improving patient knowledge Patient information leaflets Version 6: 8 July 2015 “Sick day rules” in patients at risk of Acute Kidney Injury: an Interim Position Statement from the Think Kidneys Board Sick day rules Good or bad ?

Discussion Thoughts and Questions