Driving up Quality using a CQUIN Preetham Boddana

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

Gloucestershire Hospitals

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

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

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

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

AKI FLAG Senior Review Medication Review Fluid Balance Review Early Warning Score Repeat Creatinine AKI Care Bundle in Gloucestershire Hospitals

PDSA Testing Ramps for: AKI Care Bundle t en m e ov red r p u it Im eas gh ud m rou ly a th onth m S AP S D A D DS P A P S D DS P A Cycle 2 B: Spread sticker to wider Trusts through Safety Cafes and induction Cycle 2 A: Development of Sticker wider testing Cycle 1 B: Develop E-learning for AKI to support launch of form Cycle 1 A: Design and complete local testing of sticker on Ward 7 b Process Change PDSA

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

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

AKI-CQu. IN(2013 -2014) Programme = £ 1. 5 m Target 1 Target 2 • Complete Root Cause analysis on AKI patients each month • 75% Compliant with Care bundle by March 2014

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

AKI CQu. IN Team @GRH