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

2. 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 ?

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

4. 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%)

5. AKI eAlerts 3 days experience
Great opportunity to prioritise sick patients
Baseline data: N=24
Level (2 ?false alerts)
Level
Level
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N= 16 eGFR on chart Yes=8, No =5, Out of date =3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

6. 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).

7. 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 ?

8. Discussion
Thoughts and Questions