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Acute kidney injury

Audit helps pharmacists target patients who need hydration advice

Pharmacist speaking to patient

Source: Mark Thomas / Science Photo Library

Pharmacists can help in acute kidney injury prevention by advising patients on hydration

Community pharmacists can play a “significant” role in providing hydration advice to patients who may be at risk of acute kidney injury (AKI), according to the results of an audit commissioned by the NHS’s Specialist Pharmacy Service, published on 13 January 2017.

Nearly 1,000 community pharmacies in England took part in the audit and made a record of when they gave hydration advice to two specific groups of patients — those with prescriptions for named antibiotics for treating a urinary tract infection and others who sought over-the-counter (OTC) advice about urinary symptoms, such as cystitis.

The audit involved 14,908 patients from across England, of whom 94% were given hydration advice. Of the 13,610 who presented a prescription for antibiotics, 93% were given hydration advice, whereas of the 1,298 who requested OTC advice for urinary symptoms, 97% were given hydration advice.

Only 39% of prescriptions for an antibiotic were for nitrofurantoin, which is recommended by Public Health England as the first-line antibiotic for uncomplicated urinary tract infection. However, 59% of prescriptions were for trimethoprim, which is recommended as an alternative first-line treatment if the patient’s glomerular filtration rate is under 45mL/min.

According to the audit report, failure to prescribe the recommended first-line antibiotic and to meet national guidelines on duration of antibiotic treatment are issues that need to be addressed “to deliver the antimicrobial resistance agenda”.

The results of the audit also show that around a third of patients were already taking medicines for other conditions that could impair their renal function, with 10% taking two or more. For patients aged 65 years or over, more than half were on medicines that could affect their renal function.

The report says that a nationally available audit tool “provides a very successful means” of enabling community pharmacies to contribute productively to national priorities around optimising medicines use.

“The data on antibiotic prescriptions for urinary tract infection provides some insight into current prescribing for particular patient groups and localities, relevant to the antimicrobial resistance agenda. Additional strategies are needed to reach people who do not attend the pharmacy, such as [older patients], housebound patients and those in residential care,” the report states.

The audit results were welcomed by Sue Shaw, advanced renal services pharmacist at the Royal Derby Hospital, who was involved in developing the audit: “It’s a good outcome that hydration advice was provided to over 90% of patients in the audit sample. This has shown that pharmacists are able to provide the advice routinely, when it is clearly linked to at-risk groups.”

She says that giving hydration advice ought to be standard practice and that a targeted audit such as this one, supported by learning resources, highlights to the pharmacy workforce how effective they can be.

“I would like my pharmacy colleagues to recognise that they have the potential to make an ongoing difference in this area, by talking to people who are at high risk of AKI due to the medicines that they take,” Shaw asserts.

One of the recommendations from the audit is for pharmacists to follow up housebound patients with a telephone call. “As a prescriber, I am used to following up my patients and I would like to see this follow up of advice becoming routine practice in community pharmacy,” she adds.

Carina Livingstone, interim director, medicines use and safety, Specialist Pharmacy Service

Source: Courtesy of Carina Livingstone

Carina Livingstone, interim director, medicines use and safety, Specialist Pharmacy Service, says the targeting of advice to specific patient groups at increased risk of acute kidney injury needs to be improved

Carina Livingstone, interim director for medicines use and safety at Specialist Pharmacy Service, who was also involved in the audit, says: “Because there is no one-size-fits-all ‘right’ amount of fluid, you can see why providing advice to some people, particularly those who don’t come to the pharmacy, isn’t necessarily straight forward.

“We need to improve targeting of advice to specific patient groups at increased risk of AKI and have a better understanding of how patients interpret and act on the information provided. For now, participating in the audit will have increased community pharmacists’ awareness of AKI, a key requirement of the Patient Safety Alert issued by NHS Improvement earlier this year.”

The audit is part of the three-year national campaign “Think Kidneys”, run by NHS England in partnership with the UK Renal Registry, which aims to prevent avoidable harm caused by AKI.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2017.20202279

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  • Pharmacist speaking to patient
  • Carina Livingstone, interim director, medicines use and safety, Specialist Pharmacy Service

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