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CKD HIT Udaya Udayaraj Consultant Nephrologist NBT Chronic - - PowerPoint PPT Presentation
CKD HIT Udaya Udayaraj Consultant Nephrologist NBT Chronic - - PowerPoint PPT Presentation
CKD HIT Udaya Udayaraj Consultant Nephrologist NBT Chronic Kidney Disease (CKD) Initial proposal submission - April 2013 Approved - Jan 2014 Change of leadership March 2014 First CKD HIT meeting 14 th May 2014 CKD Workstreams Prevention
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CKD Workstreams
- Prevention – Acute Kidney Injury (AKI)
- Provision of care :
- Service redesign - Telehealth, remote CKD
monitoring, CKD e-consultation
- Patient related outcomes and empowerment
shared decision making, personalised care plans
- Education
- Research
- Innovation
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AKI Challenges
- £500 million annual expenditure
- 12-15 % of hospital admissions
- ~ 60 % episodes are acquired in community
- 20-30 % avoidable
- NCEPOD AKI report- suboptimal care in hospitals
- NHS England commissioned project to reduce and
improve management of AKI
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Aims
- Risk assessment – identify patients at risk of AKI at
admission
- Early detection – e-alerts for AKI from blood tests
- Education of patients and clinical teams –
standardised intervention advice in hospitals and community
- Medicines management eg: sick day rules for ACE
i/ARBs; concurrent use of NSAIDs &ACEi and potassium sparing diuretics
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Progress
- Current position in NBT
– Risk assessment tool in all medical admissions
- Ongoing projects in NBT
– Setting up e-alert of AKI ( summer 2015) – Standardised intervention advice for AKI in hospital (June 2014) – Include AKI details in discharge summary
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Role of CKD
– Influence other non renal trusts to adopt risk assessment and setting up e-alerts – Adoption of standardised intervention advice and referral pathway ( post AKI detection) in primary care and in other trusts – Medicines management in community to prevent AKI
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Telephone Clinics
- Ideal for selected CKD/transplant patients
– Regional service – patient travels > 50 miles for 10 min consultation – Physical signs are few – Consultation directed mainly at symptoms, BP and GFR
- Barriers
– Tariff based payment by activity – IT barriers – Practical issues of getting blood tests and BP measurements at GP
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Challenges for CKD
- Projects proposed and driven by secondary
care clinicians
- Representation from all partner organisations
- Would like to hear what commissioners, GPs ,
- ther partner organisations and patients want
us to do.
- Funds – ? invest to save