1. Driving up Quality using a CQUIN
Preetham Boddana
Consultant Nephrologist ,GHNHSFT
AKI Celebration and Sharing Event
17 March 2015

2. Gloucestershire Hospitals

3. The scale of the problem
AKI is common
AKI is associated with considerable harm
AKI causes significant costs
The course and development of AKI is modifiable
360,000 cases per year in inpatients in England
20–30% of cases are avoidable
Mortality is high: 16% in under 60s; 32% in over 60s
75,000–110,000 preventable cases/year (England)
20,000–30,000 preventable AKI-related deaths/year
Source: Bedford, Kerr, Stevens et al. Forthcoming

4. AKI Opportunities AKI is not primarily a renal issue
Renal leadership can help to establish this tenant
Local groups can reiterate this and implement best practice
CQUINS can incentivize
Prevention will reduce:
Proportion requiring RRT
Long term conditions (LTC) burden
CVD
CKD
Timely investigation and treatment will:
Improve individual patient experiences and outcomes

5. Introduction of a pathway to identify and manage patients at risk of AKI @GRH
Identification of AKI
Implement the Care Bundle
Measure progress

6. Acute Kidney Injury Management Guidelines
For further information including management of grade 3 AKI, refer to the AKI protocol available on the trust intranet.

8. Gloucestershire Hospitals
AKI FLAG
Medication Review
Early Warning Score
Repeat Creatinine
Fluid Balance Review
Senior Review
We launched an AKI care bundle and created an electronic alert in our chemical pathology reporting system based on serum creatinine. The care bundle is clearly stated on the AKI sticker which is placed on the patients’ case notes. The AKI care bundle comprises senior review, medication review, fluid balance, and repeat creatinine and the sticker helps trigger this pathway.
AKI Care Bundle in
Gloucestershire Hospitals

9. PDSA Testing Ramps for: AKI Care Bundle
Improvement measured through monthly audit
Cycle 2B: Spread sticker to wider
Trusts through Safety Cafes and
induction
Cycle 2A: Development of Sticker wider testing
Cycle 1B: Develop E-learning for AKI to support launch of form
Cycle 1A: Design and complete local testing of sticker on - Ward 7b
Process Change PDSA 43 9 9

12. AKI Learning Safety Café Briefings
E-Learning module for junior doctors on AKI
AKI covered during induction to trust
Briefings on fluid balance to nurses during handover

13. AKI-CQuIN (2012-2013) Target 1 Target 2 Target 3 Programme = £880,000
30% compliant with Care bundle by September 2012
Target 2
45% Compliant with Care bundle by December 2012
Target 3
60% Complaint with care bundle by March 2013

14. AKI-CQuIN(2013-2014) Target 1 Target 2
Programme = £1.5 m
Target 1
Complete Root Cause analysis on AKI patients each month
Target 2
75% Compliant with Care bundle by March 2014

22. “Head of Marginal Gains” What can we (NHS) learn from
We need to improve further
- 95% reliability
“Head of Marginal Gains”
What can we (NHS) learn from
British Cycling Success in Olympics?

23. AKI CQuIN