Do we know what to tell our patients about medicines management and ‘Sick Day’ Rules / Holidays? Are we spreading this message? As a pharmacist I know I am in my workplace and at home! Recently when my 20year old cat, who takes ACEis to protect his kidneys, developed diarrhoea and vomiting, I found my husband temporarily withholding his medications, a ‘Sick Day’ holiday, to reduce his risk of AKI.
For people taking medicines it is very common that these are got rid of in the urine. Drugs can also affect kidney function by reducing blood supply to the kidney, blocking urine production and causing problems directly to the kidney itself. In the 2014 Think Kidneys survey, only 12% of people thought their kidneys had a role in processing medicines and 22% thought some medicine ingredients can present a danger to kidney health. So it is clear we have a way to go in helping people understand that their medicines do affect their kidneys and their kidneys affect their medicines. For people taking medicines that are usually very beneficial, our role is to give them the tools to recognise when they should suspend their medications to protect their health.
Wherever their practice location, pharmacists are strong advocates for medicines optimisation in AKI: reducing risk and avoidable harm, advising about drug dosing in kidney impairment and identifying drugs that can cause kidney damage. A community pharmacist is likely to see patients more often than any of the other health professionals; each time a medicine is supplied. They are funded by the NHS to offer a ‘New Medicines Service’ to support patients when they start on higher risk medicines. Hospital pharmacists and pharmacy technicians work closely with the multi-disciplinary team to support prescribing decisions and talk with patients about effective use of their medicines. Pharmacists working with CCGs and in GP surgeries seek to support these messages and ensure continuity of care.
I am pleased to be part of the ‘Think Kidneys’ programme through the education group, in developing a local CQUIN (a quality initiative to improve AKI management in primary and secondary care) and by helping to raise the awareness of AKI to my pharmacy colleagues.
Sue Shaw
Sue Shaw is the advanced renal services pharmacist at the Royal Derby Hospitals NHS Foundation Trust, where she works as part of the multidisciplinary renal team.
Sue was a member of the guideline development group for the NICE clinical guideline 169 on Acute Kidney Injury and now sits on the education and training workstream of the national AKI delivery group. She is an active member of the Renal Pharmacy Group committee and leads the subgroup on research.
Sue developed the national learning programme for pharmacy professionals on renal medicine and AKI with the Centre for Pharmacy Postgraduate Education (CPPE), an HEE funded organisation within Manchester Pharmacy School. She now maintains the accuracy and currency of these learning programmes to ensure ongoing relevance.
In 2013, Sue was nominated for, and won, the Clinical Pharmacist of the Year award from the professional leadership body, the Royal Pharmaceutical Society. She submitted her portfolio for assessment in 2014 and was awarded Fellow status of the Faculty of the Royal Pharmaceutical Society