Quality Improvement Plan 2014-2016

Current Quality Improvement Activity:

Our CQI activity over the last 12 months has largely been in line with national policy directives to increase specific recording of smoking status, cessation activity and cardiovascular disease risk.

• Installed Dashboard to asssist with CQI

• Improving recording of CVD risk

• Improving recording of Smoking Cessation

Although these are important, we are already performing well above the required levels and there is now room to work on additional areas.

Over the next 18-24 months we will begin an initiative to identify our patients with renal disease so that their progress can be more easily monitored.

Stage 1: IT Implementation

Set up screening terms for:

Serum Creatinine

eGFR

Albumin/Creatinine Ratio

Link these terms to laboratory results so that the data is searchable.

Stage 2: Case Identification

Record a creatinine level on appropriate patients. This should be added to most blood tests for patients where a Cr has not been recorded in the previous 12 months, or where otherwise appropriate.

Hypertensive patients or those with diabetes should undergo annual Creatinine testing.

Healthy patients over 65 should have had a creatinine recorded in the last 5 years

Healthy patients over 80 should have had a creatinine recorded in the last 2 years

Record the stage of CKD for all patients who have eGFR – cases are defined according to the criteria set by the UK National Kidney Foundation and summarised here: http://www.renal.org/information-resources/the-uk-eckd-guide/ckd-stages#sthash.ziyAXPlI.dpbs

All patients identified with stage 1 or higher CKD shall be assigned the Read Code K05.00 (Chronic Renal Failure) with a comment specifying the stage.

It is recognised that this may be sub-optimal given the lack of specificity however it may cause problems with systems migration in future if custom Read Codes are applied and the current NHS approved codes are not available in the standard implementation of MT32.

Stage 3: Treatment to guidelines

We will either use the National Kidey Foundation guidelines (a detailed document found at http://www2.kidney.org/professionals/KDOQI/guidelines_ckd/toc.htm) or the simpler but very similar guidance at http://emedicine.medscape.com/article/238798-treatment to guide our treatment of identified cases.

This CQI activity does not include assessment of treatment levels at this stage though the monitoring of measurable comorbidities (Diabetes, Hyperlipidaemia, Hypertension) is anticipated and included in the attached audit structure

Audit:

There are a number of clinical audit criteria associated with this activity:

Implementation: Quality Administrator