The 2009 NCEPOD report, Adding Insult to Injury, reviewed outcomes for patients with acute kidney injury (AKI) in hospital. The report found that medication was the most common AKI risk factor not assessed and only 15% of patients had their medication altered to renal doses. The national AKI programme Think Kidneys advises that medicines optimisation is essential to reduce the risk of AKI and mitigate its severity if it occurs. Improving drug management during AKI includes avoiding drugs with nephrotoxic potential, selecting and dosing drugs based on estimated glomerular filtration rates (GFR). The Advancing Quality (AQ) programme measures performance for the care of patients with AKI, including pharmamcist medication review.
St Helens and Knowsley Teaching Hospitals NHS Trust wanted to improve the medication review process for AKI patients.
St Helens and Knowsley Teaching Hospitals NHS Trust does not have a dedicated renal team on site and as such, there was potential for a delay in recognising and managing patients with AKI at the time of the project initiation. The need for an AKI team was identified by the Trust clinical lead, as a means to improve patient care and safety by reducing length of stay and 30-day readmissions and improving medication reviews.
To address this, a business case was submitted in 2015 to create an AKI service to include specialist AKI nurses, consultant nephrologist sessions and a pharmacist. The case was approved. Three AKI nurses and a specialist AKI pharmacist (Band 8A) started in post at the Trust in 2016. Prior to establishing this role, the pharmacy team did not have a process to undertake any formal reviews of AKI patients, nor were there any AKI specific guidelines available for pharmacists to refer to.
Read the full case study here