P98
ADHERENCE TO AKI (ACUTE KIDNEY INJURY)BUNDLE - DO DRUGS WITH
NEPHROTOXIC POTENTIAL GET STOPPED AND THEN RESTARTED DURING
ADMISSION WITH AKI?
Aisha Sadiq and Mansoor N Ali
Calderdale and Huddersfield Hospitals NHS Foundation Trust
Acute Kidney injury (AKI) is a global healthcare problem. It carries significant mortality and an
estimated 100,000 deaths in secondary care is associated with AKI. It also incurs heavy costs to the
NHS estimated between 400-600 million pounds per year.
National Confidential Enquiry into Patient Outcome and Death (NCEPOD) reported only 50% of
patients admitted with AKI had received good quality care. National Institute for Health and Care
(NICE) produced some guidelines on the prevention, recognition and management of AKI. One such
important area of focus involves prompt recognition of medications with nephrotoxic potentials and
stopping them during acute illness. However, most patient’s medications do not get re-started once the
reversible causes of AKI have been identified and AKI resolved.
AKI care bundles had been developed across acute trustswhich should be initiated on AKI diagnosis
and guide clinicians in managing it. The AKI bundle consists of different components which prompt
clinicians to make interventions. Some of the important components include management of patient’s
medicines and the intervention needed to “stop all drugs withnephrotoxic potentials” and “alter doses
of medication based on creatinine clearance”.
Purpose: To audit the practice of recognising medications with nephrotoxic potential, stopping them
during the acute illness with AKI and restarting drugs upon its resolution. The audit was also aimed to
identify pharmacy involvement with regards to advice on stopping and re-starting medications.
Design: This was a retrospective audit to identify compliance within the Trust in managing AKI as
per the Trust’s AKI bundle. The sample population were 25 inpatients identified with AKI from the
acute referrals/laboratory notification. An audit proforma was used to record the data coveringa period
of 2 months.
Findings: Adherence to AKI bundle as per the trust guideline was seen in 49% of cases, and in those
instances all nephrotoxic drugs were stopped. Unfortunately, where AKI bundle was not initiated, it
was noted not all medications with nephrotoxic potential were stopped.
Most nephrotoxic drugs were stopped within <24hours by a member of the team in 75% of the cases,
however in the remaining 25% there has been a prompt by the pharmacist either by communication on
the drug chart or in the medical notes. Also pharmacists, seemed to play an important role in
suggesting to alter medication doses in accordance with Cr Cl. Re-starting medications after
resolution of AKI seems to be an area which is poorly managed and in 50% of the cases pharmacy
had to remind restarting some if not all medications.
Conclusion: Recognising AKI by the clinicians together with AKI bundle initiation upon admission
includingconstant medication review and prompt by pharmacist leads to appropriate management and
improved outcome of patients who are on medications with nephrotoxic potential. A careful strategy
to restart some; if not all, appropriate medications needs to be undertaken prior to patient discharge
with adetailed communicationsent to the primary careupon/after discharge.