Medicines and the kidney Community pharmacy s contribution to reducing harm associated with AKI

Transcription

1 Medicines and the kidney Community pharmacy s contribution to reducing harm associated with AKI Annie Sellers, learning development pharmacist 1

2 Outline Who are CPPE? AKI learning campaign Audit on hydration messages Working with community pharmacy 2

3 Who are CPPE? Centre for Pharmacy Postgraduate Education Largest provider of post graduate educational material to pharmacy professionals in England Funded by Health Education England Mission statement: Provider of educational solutions for the NHS pharmacy workforce across England, to maximise their contribution to improving patient care. 3

4 AKI learning campaign Every year CPPE runs two learning campaigns September 2015: learning campaign on acute kidney injury 4

5 Six challenges 1. Looking at Think Kidney resources 2. Testing knowledge 3. Learning and engaging 4. Twitter chat 5. Working with the community pharmacy team 6. Making a pledge 5

6 Learning and engaging Distance learning programme sent to around 65,000 registered pharmacy professionals: 1. What is acute kidney injury? 2. Talking about kidney health 3. Acute kidney injury and the role of the pharmacy team 4. Committing to action to prevent or manage acute kidney injury 6

7 Distance learning programme content Reference 2: National Institute for Health and Care Excellence. CG169: Acute kidney injury: prevention, detection and management of acute kidney injury up to the point of renal replacement therapy. London: NICE,

8 Sick day guidance NSAIDs impairing renal autoregulation Reduction in glomerular perfusion Decompensated heart failure Uncontrolled hypertension Benefit Accumulation leading to adverse effects Reduced adherence due to nephrotoxic Risk Clinicians to provide sick day rules guidance on temporary cessation of medicines to patients deemed at high risk of AKI based on an individual risk assessment 8

9 9 Sick day rules card

10 10 Sick day guidance card

11 Sick day guidance Drug and Therapeutics Bulletin NICE guidance vomiting or diarrhoea, fever sweats or shaking risk factors or triggers withholding risky medicines 11

12 Committing to action to prevent or manage acute kidney injury Focussed on Changing practice Making a pledge 12

13 Community pharmacy There are 1.6 million visits to a pharmacy every day in England 95 percent of the population live within a 20 minute walk of their local pharmacy 79 percent of people have visited a pharmacy at least once in the last 12 months and 37 percent visit at least once a month Over 90 percent of pharmacies now have a private consultation room and many have already taken on a wider public health role 13

14 Pledges for community pharmacy Targeted over-the-counter advice and sales Medicines use review and the new medicine service Distributing sick day guidance leaflets Audit on hydration messages to prevent acute kidney injury 14

15 Targeted over-the-counter advice and sales Provision of advice to: Customers who are purchasing over-thecounter NSAIDs Customers asking for advice on sickness or diarrhoea Customers seeking relief from a urinary tract infection 15

16 Medicines use review and the new medicine service All pharmacists need to know: What acute kidney injury is How to identify patients with potential renal impairment and which medicines are implicated in acute kidney injury The sick day guidance to share with patients 16

17 Distributing sick day guidance leaflets All members of the pharmacy team need to: Know how to identify people who are at risk of developing acute kidney injury Know which people are at risk and be able to explain to them what the leaflet is about Invite people back to ask questions 17

18 Audit on hydration messages to prevent acute kidney injury Pharmacies need to: commit to undertaking the audit actively engage with this and make sure that all members of their team know what is required 18

19 What was the audit? Specialist pharmacy service, funded by NHS England Signposted to CPPE AKI programme Signposted to Sick day guidance 19

20 Audit sample All patients who presented with prescriptions for: trimethoprim, nitrofurantoin, and pivmecillinam for a UTI and All those who requested advice about urinary tract symptoms. 20

21 Audit standards 1) All patients prescribed trimethoprim, nitrofurantoin or pivmecillinam for a UTI are given advice on preventing dehydration 2) All patients requesting advice about urinary symptoms are given advice on preventing dehydration 21

22 The advice Drink plenty of water to avoid dehydration and help clear bacteria from the urinary tract Drink plenty of fluids such as water, diluted squash or diluted fruit juice If vomiting, try drinking small amounts more frequently 22

23 The advice Passing clear (near colourless) urine (wee) is a good sign that you're well hydrated If you have been told by your doctor to restrict your fluid intake, can you manage to drink about the maximum they advise? 23

24 Audit data Audit data collection ran from 1 November 2015 to 31 July 2016 Patients: 14,908 Pharmacies: % (13,610) of patients attended the pharmacy with an antibiotic prescription 9% (1,298) of patients requested advice about urinary symptoms Reference: Specialist Pharmacy Service. National AKI hydration audit report

25 Data for those with a prescription Those with a prescription 93 percent of patients received hydration advice Those asking for urinary symptoms advice 97 percent of patients received hydration advice Source: Specialist Pharmacy Service. National AKI hydration audit report

26 Other medicines Source: Specialist Pharmacy Service. National AKI hydration audit report

27 Audit Summary Overall 94 percent of patients received hydration advice from community pharmacies Advice was standardised Pharmacists are in a position to offer sick day guidance 27

28 Further work Research into UTI and dehydration linked to UTI as a trigger for AKI Further research into the risks and benefits of offering sick day guidance Benefit Risk 28

29 Working with community pharmacy Community pharmacists offer quality and consistent advice Patients have good access to community pharmacy Patients who have been recently discharged from hospital can access the new medicines service Pharmacists can offer appropriate support and signposting 29

30 Benefits of signposting to community pharmacy Takes pressure of GP colleagues Reliable signposting Provision of appropriate advice 30

31 Summary Training surrounding AKI has been offered to community pharmacy teams Patients have great access to community pharmacy Suggesting that patients speak to their community pharmacist for advice reduces pressure on GPs Advice from community pharmacy is consistent and of a high standard 31

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