My name is Jane and I am a practice nurse, this is my experience of working to improve care for CKD patients using IMPAKT™.
Leigh Family Practice is the largest in our local cluster of 13 practices. We’re split into four sites in the town of Leigh, in Wigan Borough Clinical Commissioning Group. As a team, we’re generally proud of our chronic disease management, but unfortunately CKD had been something of a poor relation in this context.
When our cluster decided to tackle CKD as a group project it seemed like a great opportunity to bridge our knowledge gap.
What we did
We formed a practice project team consisting of a lead GP (Margaret Misterek), a clinical coordinator (Suzi Parkinson), our healthcare assistant (Emma Weber), and myself, the practice nurse (Jane Rushton).
IMPAKT™ was identified by the cluster as the perfect supporting mechanism for the project. When we discussed the project as a cluster for the first time it was re-assuring to find out that all of our peers identified the same concerns around CKD management that we had.
That helped remove the fear factor of the task ahead.
IMPAKT™ was identified by the cluster as the perfect supporting mechanism for the project.
We had two ‘key’ tasks for the project and our timeframe was 12 months.
- Halving our estimated prevalence gap, which for us meant adding 42 patients to our CKD register (taking our register size from a baseline of 217 to 259 patients).
- Ensuring that 75% of our CKD register had been tested for proteinuria and managed to blood pressure targets recommended by NICE.
Creating an accurate CKD register: 1A. Patients coded as CKD
Firstly, we ensured that our existing CKD register was made accurate. Our large list size meant that this was a lengthy, yet very worthwhile process. There were over 130 patients (more than 50% of our CKD register) that IMPAKT™ queried the diagnosis for.
After resolving these queries through a combination of updating Read codes, amending erroneous details, requesting further diagnostic tests, and removing cases coded in error, we then updated the stage coding for the remaining patients based on latest eGFR data. It was a big confidence boost to the team knowing that patients were now accurately recorded.
We began to contact all of our CKD patients to make sure that they had been given their CKD diagnosis, which regretfully, prior to the project had not always been the case.
Creating an accurate CKD register: 1B. Patients not coded as CKD
IMPAKT™ also found many patients who met the CKD diagnosis criteria but had not been given a Read code. We identified 47 additional CKD patients just in the first month, already taking us past our aim to halve our prevalence gap, easy!
Our hard work paid off, and we achieved the NICE targets in 88% of our CKD patients... This is where our patients will feel the benefit, improved blood pressure control really reduces their risk of suffering vascular events
The new diagnoses didn’t stop there, we then followed up patients who had single examples of eGFRs
In the following months our CKD prevalence continued to increase. A re-audit at six months helped us to do a little further validation work and those follow-ups continued to trickle in. Our eventual register size at month 12 was 356 patients, having found 139 additional patients, more than 3x our target. We are delighted that so many more of our patients are now diagnosed so that we can provide them with better care, and improve health outcomes for the local population.
Improving care for our CKD patients
- Our startling progress meant that we could quickly shift our focus towards managing blood pressure in our CKD patients.PROGRESS
- At month three, our QOF CKD6 indicator (patients with a test for proteinuria in last 15 months) was at 66% (205/311) because we’d identified so many new patients.
Our healthcare assistant, Emma, showed remarkable enthusiasm in getting patients through the door for urine samples. Inside one month she completed an incredible 71 tests.IMPROVED PATIENT CARE
- After identifying so many new patients, we were giving ourselves more patients to manage to hit that 75% target for the second objective. From month six, we were focused on identifying our CKD patients with proteinuria, and making sure that blood pressure was controlled in all of our CKD patients.
I worked diligently alongside our GP, Margaret, to make sure that we were giving great lifestyle information to patients, and adjusting medications to help achieve better blood pressure control. I’m pleased to say that our hard work paid off, and we achieved the NICE targets in 88% of our CKD patients. This is where our patients will feel the benefit; improved blood pressure control really reduces their risk of suffering vascular events.
Sustaining our improvements
• We learnt important lessons during the project and it came to CKD”
•Suzi, our clinical coordinator, revised our CKD protocol based on our findings during the validation work using examples from the IMPAKT™
• I was proud that as a team we’d achieved both of our targets, but best of all as a practice nurse, it was great to know that the care that we are all delivering to our patients had improved and was something that we could sustain beyond the project.