Download Free Medical Support For Implementing The Nice Clinical Guideline On Acute Kidney Injury PowerPoint Presentation

Support For Implementing The Nice Clinical Guideline On Acute Kidney Injury PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Support for implementing the NICE clinical guideline on acute kidney injury".

This medical PowerPoint presentation has been developed to support services to implement the NICE clinical guideline on acute kidney injury (CG169).

Tags : diuretics, hypertension, congestive heart failure, edema, acute kidney injury, critical care medicine, critical care medicine PowerPoint presentation

Published on : Mar 28, 2023 | Views : 878 | Downloads : 0

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Slide 1-

Support for implementing the NICE clinical guideline on acute kidney injury (CG169)
Slide 2-

What this presentation covers Background Scope and methodology Recommendations Discussion Find out more
Slide 3-

Background Acute kidney injury (previously known as acute renal failure) covers a wide spectrum of injury to the kidneys, not just kidney failure Up to 18% of all hospital admissions have AKI Inpatient AKI-related mortality is between 25 and 30% Between 20 and 30% of cases of AKI are preventable. Prevention could save up to 12,000 lives each year NHS costs related to AKI are between £434 and £620 million per year
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NCEPOD: Key findings AKI avoidable in 14% of cases Only 50% of patients received “good care” Post admission AKI: poor recognition and care 24% did not receive adequate senior review Quality of care in this group was judged to be less good 85% did not have documented evidence of critical care outreach involvement June 2009
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Background: prevention and early identification AKI can be readily identified by close monitoring of routine serum creatinine and urine output results AKI can be prevented by early recognition and treatment of the underlying cause, for example: Early treatment of infections/sepsis Early treatment/prevention of dehydration Correcting hypovolaemia AKI can also be prevented by: Monitoring use of drugs such as NSAIDs and ACE inhibitors, especially if a patient is acutely unwell Taking care with at-risk patients who need iodinated contrast agents with scans
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Use an early warning score that recognises and responds to deterioration and acute illness Staff should have competencies in: monitoring measurement interpretation recognition and prompt response to acute illness (CG50) Observations and assessment
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Guideline development
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Guideline scope Multidisciplinary input from stakeholders, including Royal Colleges and NHS trusts Practical guidance for NHS services Not a textbook of acute kidney injury Avoids duplication of aligned NICE guidance, such as the clinical guideline on acutely ill patients in hospital (CG50) Covers: Adults (excluding pregnancy and renal transplant patients) Young people and children older than 1 month (excludes neonates)
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Outside of scope Renal replacement therapy, including dialysis (existing NICE guidance covers this) The use of biomarkers (evidence of cost effectiveness versus standard care not yet available) Intravenous fluid management in adults and in children and young people (separate NICE guidelines currently in development) Management of less common causes of acute kidney injury, such as vasculitis and haemolytic uraemic syndrome
Slide 10-

Identifying acute kidney injury in patients with acute illness Identifying acute kidney injury in patients with no obvious acute illness* Assessing risk factors in adults having iodinated contrast agents and in adults having surgery Ongoing assessment of patients in hospital Detecting acute kidney injury Identifying the cause(s) of acute kidney injury Urinalysis* Ultrasound Managing acute kidney injury Relieving urological obstruction* Pharmacological management* Referring for renal replacement therapy* Referring to nephrology Information and support for patients and carers * not a KPI, but considered a key issue by the guideline development group AKI: Key priorities for implementation
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Risk factors: adults Chronic kidney disease (or history of) Diabetes Heart failure Sepsis Hypovolaemia Age 65 years or over Use of drugs with nephrotoxic potential (for example, NSAIDs, ACE inhibitors) Use of iodinated contrast agents within past week Oliguria Liver disease Limited access to fluids, e.g. via neurological impairment Deteriorating early warning scores Symptoms or history of urological obstruction
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Risk factors: children and young people As for adults, with the following additional risks: Abnormal or deteriorating paediatric early warning score Young age, disability or cognitive impairment with dependency on carers for access to fluids Severe diarrhoea, especially bloody diarrhoea Signs or symptoms of nephritis (for example, oedema or haematuria) Haematological malignancy Hypotension
Slide 13-

Assessing risk of AKI Acute illness: in adults in children and young people Adults having iodinated contrast agents Adults having surgery In patients with no obvious acute illness, with risk factors
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Acute kidney injury stages * Urine output of less than 0.5 ml/kg/hour more than 8 hours in children and young people
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Detecting AKI Investigate for AKI when risks factors are present Compare serum creatinine with the patient’s baseline Urine output < 0.5ml/kg/hour for more than 8 hours in children and young people In children and young people – a 25% or greater fall in eGFR
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Risk factors in adults having surgery or iodinated contrast agents
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Adults: ongoing hospital assessment Use early warning scores (track and trigger systems) (CG50) Ensure there is a system in place to recognise and respond to oliguria <0.5ml/kg/hour (if not part of early warning score) Continue to monitor serum creatinineregularly in all patients with, or at risk,of acute kidney injury
Slide 18-

Children and young people: ongoing hospital assessment Consider a paediatric early warning score (PEWS) to identify children and young people at risk of acute kidney injury Record physiological observations at admission and then according to local protocols for given PEWS Increase the frequency of observations if abnormal physiology is detected Use PEWS with multiple-parameter or aggregate weighted scoring systems that allow a graded response and include: heart rate respiratory rate systolic blood pressure level of consciousness oxygen saturation temperature capillary refill time
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Patients without obvious acute illness A rise in serum creatinine could indicate acute kidney injury rather than a worsening of any existing chronic kidney disease
Slide 20-

Identifying the cause of acute kidney injury and ultrasound Record cause(s) of AKI in the patient’s notes, for example, “AKI secondary to sepsis” Urinalysis: via dipstick. If proteinuria or haematuria in absence of infection/trauma consider nephritis diagnosis. DO NOT routinely perform ultrasound scan of the renal tract if the cause of AKI has been identified DO offer urgent ultrasound scan of the renal tract within 24 hours of detection of AKI: if there is no identified cause if there is risk or suspicion of renal tract obstruction
Slide 21-

Interventions: iodinated contrast agents in adults
Slide 22-

Managing AKI Pharmacological management Relieving urological obstruction Referral Information and support for patients and carers
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Relieving urological obstruction Refer all patients with upper tract urological obstruction to a urologist. Immediate referral if one or more of following present: Pyonephrosis Obstructed single kidney Bilateral upper urinary tract obstruction Complications of AKI secondary to urological obstruction When nephrostomy or stenting required – undertake as soon as possible and within 12 hours of diagnosis
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Referral
Slide 25-

Patient information and support Discuss immediate treatment options, monitoring, prognosis, and support options as soon as possible. Give information about long-term options, monitoring and self- management in collaboration with the multidisciplinary team. Discuss future risk of AKI, especially for patients with eGFR < 60 or those with neurological or cognitive impairment. In particular, discuss the risk associated with: conditions that may lead to dehydration use of drugs with nephrotoxic potential, including over the counter NSAIDs.
Slide 26-

Chronic kidney disease stages
Slide 27-

Discussion 1 How can your trust’s admission or clerking proforma be adjusted to include an AKI risk assessment? What system could be used in your trust for reporting AKI alerts via laboratory services? What does your trust’s AKI management pathway look like? How can your trust ensure access to 24-hour nephrology/ urology services? What processes are in place within your radiology department to identify high-risk patients requiring iodinated contrast? How can pharmacists in your trust support AKI-related initiatives? For example, involvement in ward rounds or an electronic system to review medication/nephrotoxic drugs.
Slide 28-

Discussion 2 How does your ward or team currently identify a decline in urine output in an inpatient with acute illness? If you suspect AKI in an acutely ill patient, what investigations or checks should you run? When should a clinical response be escalated for suspected AKI? What information do you provide for patients and carers about AKI?
Slide 29-

Reflection: learning and actions What did you learn from today’s session? And how does this relate to your clinical practice? What are the key messages from the NICE guideline? What will you do differently when you return to your workplace or clinical practice? Did you identify any further learning needs during today’s session?
Slide 30-

NICE PathwaysAn online tool providing quick and easy access,topic by topic, to the full range of guidance from NICE Click here to go the pathway
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NICE Evidence Services Click here to go to NICE Evidence Services AKI page
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If background information on methodology is not appropriate for your audience, or if you have less than an hour available for your presentation, please delete this and the following 4 slides. If limited time is available, you may benefit from using just one of the ‘discussion’ slides. Please delete this note before using the presentation.
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Developing the recommendations 1 Each recommendation relates to an original clinical question. The clinical questions are based on the clinical areas in the scope and are formulated into PICO method questions: Population Intervention Comparison Outcome(s) Each question is addressed with a systematic review of the evidence: comprehensive search and sift strategy used to find studies studies are reviewed and quality assessed using NICE quality checklists data extracted into evidence tables outcome data synthesised into a meta-analysis (where possible) Each outcome is assessed for risk of bias using GRADE
Slide 34-

Developing the recommendations 2 Recommendations are formulated based upon: available clinical evidence Cost-effectiveness evidence GDG expert opinion The strength of the evidence is reflected in the wording of the recommendation , e.g.: ‘offer’, ‘refer’, ‘advise’ are used as a direct instruction from strong evidence, therefore strong recommendations ‘consider’ is used for weaker evidence The rationale for making the recommendations is clearly explained in the ‘Linking Evidence to Recommendations ‘ sections of the full guideline
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Versions of NICE clinical guidelines NICE produces 4 versions of its clinical guidelines: The FULL GUIDELINE, contains all the recommendations plus details of the methods used and the underpinning evidence. The NICE GUIDELINE presents the recommendations from the full version in a format suited to implementation by health professionals and NHS bodies. The NICE PATHWAY is on an online tool for health and social care professionals that brings together all related NICE guidance, quality standards and implementation tools on a topic in a set of interactive flowcharts. INFORMATION FOR THE PUBLIC is written using language for people without specialist medical knowledge.
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AKI Guideline Development Group, the National Collaborating Centre and NICE team Guideline Development Group Andrew Lewington Annette Davies Anne Dawnay Chris Laing Coral Hulse David Milford Fiona Loud Mark Devonald Mark Thomas Marlies Ostermann Nicholas Palmer Sue Shaw Expert advisors John Lemberger Lyda Jadresic Mark Downes Mark Rigby Rajib Pal Shelagh O’Riordan National Clinical Guideline Centre Caroline Blaine Elisabetta Fenu Joanna Ashe Izaba Younis Ralph Hughes Saoussen Ftouh Susan Latchem NICE project team Alison Foskett Anne-Louise Clayton Ben Doak Elaine Clydesdale Emma McFarlane Jasdeep Hayre Judith Thornton Sharon Summers-Ma
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Find out more Visit http://guidance.nice.org.uk/CG169 for the: Guidance, including the full version with evidence tables NICE pathway Information for the public Baseline assessment tool Clinical audit tools Costing statement In February 2014, an AKI e-learning module for nursing will also be published
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What do you think? Did the implementation tool you accessed today meet your requirements, and will it help you to put the NICE guidance into practice? We value your opinion and are looking for ways to improve our tools. Please complete this short evaluation form If you are experiencing problems accessing or using this tool, please email implementation@nice.org.uk To open the links in this slide set right click over the link and choose ‘Open Hyperlink’