320 AKI-ng for better adherence: a quality improvement initiative on the medication ‘sick day rule’ in patients over 65 with acute kidney injury (AKI)

Abstract

Abstract Background The successful mitigation of Acute Kidney Injury (AKI) among older patients is contingent on meticulous medication management, specifically adherence to the medication ‘sick day rule’. These rules, recommended by the National Institute for Health and Care Excellence (NICE) in their guidelines ‘Acute kidney injury: prevention, detection and management’, involves the temporary cessation of certain medications during episodes of acute illness. However, suboptimal adherence to this rule presents a considerable challenge in clinical practice. This quality improvement project aimed to address this issue, seeking to enhance adherence to the sick day rule among patients over the age of 65 admitted with AKI. Methods Initially we performed a medication reconciliation on all patients admitted to the medical take over a five-day period. Our intervention involved the distribution of information cards that clearly detailed the NICE guidelines. The cards were displayed prominently in key medical admission areas and could attach to doctors’ identification badges. We also provided education to Non-Consultant Hospital Doctors at Grand Rounds. Results Data collected revealed that of the 92 patients over 65 admitted, 27 met the AKI criteria. 23 of these 27 AKI patients were on medications that could exacerbate their AKI, while only 6 had all appropriate medications held. This trend extended to specific medication categories: only 8/19 patients on ACE inhibitors/ARBs, 1/5 on SGLT2 inhibitors, and 4/9 on metformin had their medication held. However, both patients on NSAIDs had their medication held, indicating a better adherence rate. Conclusion The goal of this quality improvement initiative is to bolster adherence to the medication sick day rule, thereby potentially reducing the incidence and severity of AKI in our older patient population. We plan to reaudit in the coming weeks to assess the impact of our intervention, affirming our ongoing commitment to improving patient outcomes through evidence-based quality improvement strategies.