1. RESEARCH POSTER PRESENTATION DESIGN © 2015
www.PosterPresentations.com
Acute kidney injury (AKI) is a sudden and recent reduction in one’s
kidney function. It is known to be a globally emerging healthcare
issue. It is estimated that one in five which is 20% of emergency
hospital admissions are linked to AKI and about 65% of AKI cases
start in the community. Those who are frail such as people over the
age of 65 and also patients who are taking NSAIDs, ACEi, ARBs,
Diuretics or Metformin are at increased risk of AKI. 1, 2
Persistent diarrhoea, vomiting, fever and low fluid intake can cause
dehydration in the body and eventually trigger AKI especially in
older patients. It has been reported that AKI is associated with
urinary tract infection (UTI) and subsequent hospital admission.
Therefore it is essential to give advice on maintaining fluid intake in
these patients. 3
This audit mainly focused on patients who presented in the pharmacy
with a prescription for a UTI including Trimethoprim and
Nitrofurantoin, which is not widely used in other infections and also
patients who were wanting advice for urinary symptom without
visiting their GP.
Therefore pharmacists play an important role in preventing AKI from
occurring in the patients by; giving them advice on fluid intake and
regularly reviewing patients on their use of certain medications that
may deteriorate renal function. 4
INTRODUCTION
AIM
Targeting all patients who presented in the pharmacy:
• With prescriptions for Trimethoprim and Nitrofurantoin
• All OTC patients who requested advice about urinary symptoms
at any age
By using the data collection form as shown:
POPULATION AND SAMPLE
Advice for patients with urinary symptoms
RESULTS AND DATA ANALYSIS DISCUSSION
According to the results, it shows that only 62.5% of patients with
UTI prescriptions and 100% of patients requesting advice for
urinary symptoms were given verbal and/or written advice on
preventing symptoms. The percentage of patients with UTI
prescriptions given verbal and/or written advice on preventing
dehydration was only 62.5% and does not meet the audit standard,
whereas the percentage of patients requesting advice for urinary
symptoms meets the standard of 100%. However, it should be
noted that this is a very small sample size and therefore it is not
representative.
The reasons for the inability to meet the audit standard might be
due to the busyness in the dispensary and shortness of staff that
eventually lead to lack of time to counsel and give patients advice
on preventing dehydration. Staff do not have plenty of time to have
much conversations with patients. Besides that, some patients do
not have plenty of time to spare in the pharmacy for counselling
and advice. Some patients are not accessible because their
medications are collected by their carers or representatives.
In order to reduce and prevent AKI from occurring among patients
especially those at high risk, staff and pharmacists should spend a
bit more time in counselling patients on the importance of fluid
intake. Always advise patients to read the Patient Information
Leaflet (PIL) provided with the medication and focus more on the
importance of increasing fluid intake and compliant in taking their
medication. Staff can always advise the carers or representatives to
pass on the hydration messages to the inaccessible patients.
Otherwise, always provide written advice together with the
medication so that the patients will be able to read.
CONCLUSION
 Community staff should spend more time in counselling and
advising patients on AKI.
 Provide written hydration messages and advice for patients.
 Pharmacists need to regularly review patients’ use of
medications and their compliance.
REFERENCE
1. Acute Kidney Injury Programme – Think Kidneys [Internet]. England.nhs.uk. 2016 [cited 25 March 2016].
Available from: https://www.england.nhs.uk/patientsafety/akiprogramme/
2. Think Kidneys [Internet]. Acute Kidney Injury. 2016 [cited 26 March 2016]. Available from:
https://www.thinkkidneys.nhs.uk/aki/
3. Hydration messages to prevent acute kidney injury clinical audit [Internet]. PSNC Main site. 2016 [cited 25
March 2016]. Available from: http://psnc.org.uk/contract-it/essential-service-clinical-governance/hydration-
messages-to-prevent-acute-kidney-injury-clinical-audit/
4. Shaw S, Coleman A, Selby N. Acute kidney injury: diagnosis, staging and prevention [Internet].
Pharmaceutical Journal. 2012 [cited 2 April 2016]. Available from: http://www.pharmaceutical-
journal.com/learning/learning-article/acute-kidney-injury-diagnosis-staging-and-
prevention/11098637.article?adfesuccess=1
5. Livingstone C. Community Pharmacy Audit on Hydration Messages to Prevent Acute Kidney Injury -
[Internet]. Medicinesresources.nhs.uk. 2015 [cited 5 January 2016]. Available from:
http://www.medicinesresources.nhs.uk/en/Communities/NHS/SPS-E-and-SE-England/Meds-use-and-
safety/QIPP/Preventing/Community-Pharmacy-Audit-on-Hydration-Messages-to-Prevent-Acute-Kidney-
Injury/
The aim of this audit was to reduce and prevent AKI occurring in
patients (especially those who are on medication that may cause the
deterioration of renal function).
Pre-registration Trainee Pharmacist 2015/16
Kai Yuen Ho
Audit on Hydration Messages to Prevent Acute Kidney Injury
OBJECTIVES
The objective of this audit was to:
1. Identify patients at risk of AKI.
2. Determine what advice patients received following receipt of
antibiotics for UTI.
3. Determine what advice was given to patients experiencing
urinary symptoms.
Once this was achieved, then the aim was to ensure patients at risk
of AKI received appropriate advice regarding hydration and the
optimal use of their medicines.
STANDARD AND TIME FRAME
This audit was carried out for approximately 3 to 4 weeks and
included a minimum of 15 patients. The standard of this audit was
to:
 Advise on prescribed antibiotics for UTI (standard 100%)
 Advise OTC patients that request advice about urinary
symptoms (standard 100%)
Patients at increased risk from dehydration
Total number of patients taking any of the
medicines listed under other prescribed medication
5
Total number of patients aged 65 or over 9
Advice for patients prescribed antiobiotics for UTI
DATA COLLECTION
Dates of audit 11/1 to 4/2 and
22/2 to 26/2
Total number of days 24
Total number of patients in audit 17
Number of patients with UTI prescription 16
Number of patients with UTI prescription given
verbal and/or written advice on preventing
dehydration
10
Number of patients requesting advice about
urinary symptoms
1
Number of patients requesting advice about
urinary symptoms given verbal and/or written
advice on preventing dehydration
1
HYDRATION MESSAGES GIVEN
Pie Chart 1. This pie chart shows that 62% of patients
prescribed antibiotics for UTI were given verbal and/or
written advice on preventing dehydration, whereas 38%
were not given any advice.
Pie Chart 2. This pie chart shows that 100% of patients
requesting advice for urinary symptoms were given verbal
and/or written advice on preventing dehydration.
 Drink plenty of water to avoid dehydration and help clear
bacteria from the urinary tract.
 Drink plenty of fluids such as water, diluted squash or
diluted fruit juice. These are much more effective than large
amounts of tea or coffee. Fizzy drinks may contain more
sugar than you need and may be harder to take in large
amounts.
 If you're finding it difficult to keep water down because
you're vomiting, try drinking small amounts more
frequently.
 Studies have tried to establish a recommended daily fluid
intake, but it can vary depending on the individual and
factors such as age, climate and physical activity.
 Passing clear or near colourless urine is a good sign that
you're well hydrated.
 If you have been told by your doctor to restrict your fluid
intake, can you manage to drink about the maximum they
advise? 5