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

2. Learning Objectives
Hear what has been
done in Local Health
Economies

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

4. 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

5. 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

6. AKI – Classification & Alerts
AKI Stage
Creatinine Criteria
Urine Output Criteria
Predicted Nos / year of AKI in 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

7. UK Renal Registry Data for UHNM

8. UHNM Sick Day Rules

11. 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

12. Questions