Acute Kidney Injury toolkit

AKI Guidance, Quality Standard and Patient Safety Drivers

NICE AKI Guideline
Updated in 2019, the NICE AKI guideline is primarily intended to support the delivery of care by non-specialist clinicians working in a range of settings. The guideline highlights a need for early intervention and emphasises ‘the importance of risk assessment and prevention, early recognition and treatment’

NICE AKI Quality Standard
Through a shared learning database, NICE have published links to Think Kidneys resources to support implementation of the the AKI Quality Standard.

National Patient Safety Drivers
A number of national levers were used to support improvement in the detection, treatment, management and prevention of AKI. These levers have included two patient safety alerts, published by NHS England and subsequently by NHS Improvement and a CQUIN.

NICE AKI Indicators for General Practice
NICE recommend that general practices establish and maintain a register of all patients who have had an episode of AKI.

Bury CCG Post-AKI Care Final Report April 2019

In keeping with NICE recommendations for general practices to maintain an AKI register, the Bury CCG report presents results from an audit on the management of patients who have had an episode of care complicated by AKI.

Think Kidneys Resources

Care Homes
Think Kidneys has developed practical resources to raise awareness and help with the prevention, detection and management of AKI in care homes. The work was done by a cross-professional group comprising health care assistants, nurses, dietitians, care home managers, commissioners, hydration specialists and academics.

Clinical Biochemists
Resources to assist laboratory teams in the implementation of the algorithm for reporting AKI warning stage test results, transmitting data to the UK Renal Registry with examples of best practice and top tips.

Commissioners
CCGs have in some areas been working across the whole health community, to improve safety and incidence rates of AKI.

Community Services
Publications and resources for clinical and support staff working in the community to help prevent, detect, treat and manage patients at risk of, or with, acute kidney injury.

Junior Doctors
Resources for use in secondary care including the minimum care bundle, who’s at risk of AKI and medicines optimisation and the Think Kidneys AKI App.

Mental Health
Information and resources for clinicians working in mental health to help prevent, detect and know how to manage patients at risk of, or with, acute kidney injury.

Nurses
Nurses, wherever they work, have a vital role to play in the prevention, detection and treatment of AKI. These resources are for all nurses, and have been added to the website following Think Kidneys discussions with AKI Nurses at their network meeting. The resources are relevant and useful for nurses working at all levels and in all sectors of the NHS, and include work developed by AKI nurses.

Pharmacists
Think Kidneys have provided a range of resources for pharmacists.

Primary care
Think Kidneys has developed a range of resources specifically for primary care. The links provide members of the multidisciplinary team caring for people with, or at risk of AKI with information and guidance on how to respond. The aim is to improve safety and outcomes for patients.

Secondary Care
Publications and tools for clinicians working at all levels and in all specialties across secondary care.

References and Further Reading

The Renal Association and British Society for Heart Failure have published national guidance to understand changes in renal function associated with drug treatment in heart failure.

GP and medical artist, Dr Morium Howlader presents 'The Journey of the Kidney' outlining the policy timeline and the emergence of AKI as a national priority.

This work was supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Greater Manchester. The views expressed in this toolkit are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care.

To the best of our knowledge, the contents of this publication are in line with National Institute for Health and Care Excellence guidance relating to the management and treatment of acute kidney injury. Professional advice should be sought before taking, or refraining from taking, any action on the basis of the content of this publication. We cannot be held responsible for any errors or omissions therein, nor for the consequences of these or for any loss or damage suffered by readers or any third party informed of its contents. The AKI Quality Improvement Project Steering Group disclaims all liability and responsibility arising from any reliance placed on the information contained in this publication by you or any third party who may be informed of its contents.

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Acknowledgements

A number of organisations, working groups and individuals contributed to the development of the AKI post-discharge guidance.

AKI RAND Consensus Panel

• Simon Sawhney
• Sarah Worboys
• James Larcombe
• Ben Carrigan
• Clare Allinson
• Nigel Taylor
• Zahra Iqbal
• Alistair Bateman
• Nick Jones

British Society for Heart Failure

• Paul Kalra
• Ahmet Fuat
• Teik Goh

NHS Education for Scotland

• Duncan McNab
• Royal Pharmaceutical Society
• Liz Butterfield

RCGP Overdiagnosis Group

• Margaret McCartney
• Jane Wilcock
• Doug McKechnie

Others

• Dr Krishnadas Thulasidoss
• Jeffrey C Fink
• Rebecca Doerfler
• Darren Green
• Jeffrey Schryer
• Leonard Ebah
• Prasanna Hanumapura
• Ally Moonie
• Claire Oates
• Owen David
• David Jewell