Think Kidneys for care homes - Wessex

Acute Kidney Injury and Care Homes

Wessex AKI in the Community event - 24 February 2016

Recognition that AKI is an emerging healthcare issue New technology and better information Increasing number of people living longer with long term conditions and therefore at increased risk of AKI Need for education and improved outcomes for patients Holistic approach – need to improve prevention, detection, management and treatment of AKI Two major drivers - NHS England Patient Safety Alert followed by the Five Year Forward View

What prompted Think Kidneys? The drivers

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‘40000 excess deaths pa’ (Kerr et al April 2014)


Spring 2014 Collaboration between NHS England and the UK Renal Registry Team of 100 experts and interested health professionals – nephrologists, acute physicians, GPs, pharmacists, nurses etc.Guidance for minimum care in an acute settingMedicines Optimisation guidanceGuidance for primary careRisk toolsCampaign for pharmacistsWorking with Care Homes

Think Kidneys programme commences


Think Kidneys objectives

Develop and implement tools and interventions for prevention, detection, treatment and enhanced recovery

Promote effective management of AKI

Provide evidence-based education and training programmes

Highlight importance of AKI to commissioners, health care professionals and managers


Think Kidneys Website


Website Resources for Primary Care


‘Think Kidneys’ AKI Programme

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Developed case studies of patients at risk of acute kidney injury Communities at risk document published describing the communities who are at risk of acute kidney injury Acting as a portal to other areas on the website AKI risk calculator for secondary care AKI risk calculator for primary care Patient leaflet

Risk workstream


Develop a risk matrix – one page decision tree linked to Map of Medicine Develop prevention bundle / guidance for 1° and 2°care for ‘at risk’ Integration of the identification of AKI into current care planning tools and link with Year of CareProduction of ‘stop’ card for patients

Risk workstream – coming next…..


Identification of credible educational products that already exist Identifying endorsement of educational products Running events for primary care, pharmacists, care home stakeholder Developing changes to primary care curriculum with RCGP and others Planning public campaign to increase general knowledge of kidney function and hydrationCPPE education campaign Autumn 2015 for pharmacists and pharmacy technicians

Education workstream….work to date


Discussing with GPC extending curriculum to include renal and AKI for pharmacy Approach nursing schools to extend curriculum to include renal and AKI for nurses Review primary care bundle being produced by the intervention workstream Identify a suitable education resource for those who have had an episode of AKI Develop and deliver the public campaign

Education workstream….coming next


People don’t have a comprehensive understanding of what their kidneys do, how to keep them healthy, or what acute kidney injury is

About half of the population don’t think their kidneys make urine, and you’re more likely to know this if you are older

Very few people know that kidneys help in the processing of medicines

More people in the research believe that the kidneys help remove waste from the body than thought they made urine

More people thought the kidneys made urine rather than removing excess fluid from the body

A quarter thought that the kidneys helped control the body’s chemical balance

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Findings from Ipsos MORI poll summer 2014

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National campaign to educate the public, patients and carers as well as health and care professionalsEstablished Care Home Working Group Raising awareness of our work across health and social carePaediatric nephrology and mental health issues Supporting primary care with guidance and tools

Focus now……


What does the offer to Primary Care consist of?


Think Kidneys in Care Home settings

Wherever you work and whatever your role in health and/or care you should be aware of AKI. This will enable you to understand how to reduce the risk of AKI for residents in your home.

Health and care professionals need to be well informed and proactive, to understand who is at risk, take an active lead in prevention, learn how to recognise AKI and help the person to recover.

Staff working in care and nursing homes can play a vital role in the early detection, treatment and management of people who may have had an episode of AKI or may be at risk of AKI.


Preventing acute kidney injury

Staff working in care and nursing homes can play a vital role in the early detection, treatment and management of people who may be at risk of AKI.

Think Kidneys have developed a guide and PowerPoint slide set for care home staff .


Tips for the prevention of acute kidney injury

Fluid balance

Dehydration is the underlying cause of many common conditions including constipation, falls, urinary tract infections, pressure ulcers, malnutrition, incontinence, confusion and pre renal AKI.

The elderly are more prone to dehydration.

• a person may lose the ability to recognise thirst. • poor mobility and incontinence may mean a person

avoids drinking enough.If a person has AKI they may pass less urine than usual, or pass no urine at all.


Staying hydrated

Some residents may need further support to stay hydrated.

For example:

Beakers instead of cups

Support and encouragement to maintain fluid intake throughout the day

It could be as simple as set drink routines rather than relying on thirst alone

Jelly and other fluid-rich foods can be offered to increase fluid intake if the resident doesn’t want to drink

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Tips for the prevention of acute kidney injury


Assessing fluid balance in residents

When you start to assess fluid balance you may face some barriers.

The following slides are to help overcome these barriers.


Problem:The resident goes to the toilet independently and doesn’t tell the carer so it isn’t recorded on the chart.

Can the residents record their own balance? Explain the importance of recording it and give them a chart to complete.

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Assessing fluid balance


ProblemThe relatives give drinks to the resident so it is difficult to record how much fluid is being taken.

Give the relatives a sheet with the amounts on. Get them to document the amounts on fluid balance. This works for some residents too

To help understand the quantities, how much fluid do you think is in these…?

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Assessing fluid balance


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Assessing Fluid Balance

Standard glass = 200mls

Standard Cup = 150mls

Standard Jug = 1000mls


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Assessing urine output

Problem:The resident is incontinent of urine, making it difficult to assess how much has been passed.

If weighing the sheet is an impractical proposition, (and most often it is), try estimating.

Is this so impossible?


How much urine is here?

About 50 mls

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How much urine is here?

About 200 mls

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What can carers do to prevent Acute Kidney Injury?

Think Kidneys:

When assessing residents:

Have they passed urine?

Do they show signs of dehydration?

Do they have any risk factors for AKI?

If they are ill with sickness and/or diarrhoea they may need to temporary stop some medications

Ask the nurse in charge for a visit from the GP


Case study

Marjory is an 83 year old resident in your care home

Lived in the care home for three years after she fell at home and fractured her hip

She has lost confidence in walking and likes to have assistance to walk around the home

She takes ibuprofen for some pain in her hip and has tablet controlled diabetes

She has some heart failure and takes Furosemide and Ramipril

Do you think she is at risk of AKI? Why?


Answers to Case Study

Marjory is at risk of AKI:

Older people are the group most at risk of AKI

Older patients are especially prone to dehydration – particularly if they also have dementia or frailty, making food and fluid intake more difficult, particularly if they are reliant on others for access to fluids

Patients with heart failure often have an element of Chronic Kidney Disease and are on diuretics and medicines to regulate the blood pressure

Metformin (a diabetes drug) is excreted by the kidneys, and therefore raises the risk of AKI


Think Kidneys BPKA AKI leaflet


Ten minute video – now available on the Think Kidneys Website

https://www.thinkkidneys.nhs.uk/aki/videos/gptv-video/

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GP TV Video






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Coming soon!


Guidance for Primary Care in responding to the e-Alerts

Medicines Optimisation for Primary Care

Primary Care Risk Matrix

STOP at risk of AKI cards

Register on Think Kidneys Website for newsletter and latest information.

References

References:

Kerr M, Bedford M, Matthews B, O’Donoghue D. The economic impact of acute kidney injury in England. Nephrol Dial Transplant (2014) 29: 1362–1368.

National Confidential Enquiry into Patient Outcome and Death (NCEPOD) 2009. Acute Kidney Injury: Adding Insult to Injury.

National Institute for Health and Care Excellence (NICE) 2013, Clinical guideline 169, Acute Kidney Injury.

Selby NM, Crowley L, Fluck RJ, McIntyre CW, Monaghan J, Lawson N, Kolhe NV. Use of electronic results reporting to diagnose and monitor AKI in hospitalized patients. Clin J Am Soc nephrol. 2012 Apr;7(4):533-40. doi: 10.2215/CJN.08970911. Epub 2012 Feb 23

Urine colour chart: http://jbfitnesssystems.com/eddie-vendetta-part-2/

Claire Stocks - Sister – Cardiac Arrest Prevention Team Darlington Memorial Hospital


http://jbfitnesssystems.com/eddie-vendetta-part-2/

http://jbfitnesssystems.com/eddie-vendetta-part-2/

For further information regarding Acute Kidney Injury please see the

Think Kidneys Website

www.thinkkidneys.nhs.uk

Healthcare

Think Kidneys for care homes - Wessex