Understanding the Implementation of Sick Day Guidance to Prevent Acute Kidney Injury - New Evaluation Report Published

Our latest evaluation report shows that a range of interventions, rather than a single approach, are needed to best tackle the harm associated with Acute Kidney Injury (AKI) in primary care. Up to one in five emergency admissions into hospital are associated with AKI, with evidence of increased frequency, intensity and duration of hospitalisation. 

Associated with poor short and long-term outcomes, AKI is a syndrome which is common, harmful, costly but often preventable. AKI intervention is therefore a key health priority across the UK, with resources aimed at reducing the harm associated with AKI being developed, and work being undertaken to bring together primary and secondary care initiatives to ensure a shared strategy and optimise kidney care at a national and local level. In a project led by Salford Clinical Commissioning Group (CCG), NIHR CLAHRC Greater Manchester recently collaborated with the CCG, Salford Royal NHS Foundation Trust (SRFT) and Salford Partnership for Advancing Renal Care (SPARC) to deliver and evaluate the process of implementing and using one such project (focussed around the use of sick day guidance) in primary care to help prevent AKI. The project was informed by several areas of development and national guidance:

• Work conducted in NHS Highland which has led to medicine sick day guidance for patients at risk of AKI, being made available nationally through the Scottish Patient Safety Programme.
• Guidance from the National Institute for Health and Care Excellence and the Royal College of Physicians of Edinburgh, which recommend that temporary cessation of medicines should be considered during times of acute illness, for people at risk of AKI.
• In England, the Think Kidneys Interim position statement on ‘sick day’ guidance which highlights the potential benefits of providing sick day guidance, as well as the potential harms and recommends that widespread implementation should only be undertaken in the context of a formal evaluation.

Undertaken between March 2015 and January 2016, key objectives of the project included understanding the factors surrounding the implementation of sick day guidance, with a view to providing a platform for a larger scale mixed method evaluation. In order to address that, the project was conducted in two strands: implementation (consisting of preventative interventions, supported by educational events) and a mixed methods evaluation. Sick day guidance cards were administered by general practices and community pharmacists in the CCG area to some patients who may have benefited from stopping certain medicines (those listed on the cards) when sick to avoid damaging their kidneys, in the second phase medicine management pharmacists in primary care implemented kidney health initiatives to support AKI prevention/care.

As a result, we analysed the implementation of the sick day guidance cards in general practice and community pharmacy, determined the factors influencing the acceptability of kidney health initiatives to patients at risk of AKI and their carers and gained an understanding of the role medicine management pharmacists play in implementing kidney health quality improvement initiatives. By employing specific qualitative and quantitative (using the Salford  Integrated Record – SIR) evaluation methods, the research  found that sick day guidance cards  focussing solely on medicines management may be of limited benefit without either adequate resourcing or if delivered as a standalone intervention, and concluded that the development and evaluation of a range of primary care interventions, with a focus on patient health outcomes is needed to tackle the harm associated with AKI.

More information – and to get in touch
To access further information on the project, read the full research findings in the newly published Sick Day Guidance Report and Executive Summary, please see the dedicated project page.  You can also contact Dr Susan Howard, Programme Manager, or Dr Tom Blakeman, academic lead. 

We are always keen to hear from organisations who have ideas on how we might work together to make improvements to healthcare.

Date Published: 21/02/2017