1 / 22

Making life easier…

Making life easier…. Dr Michael Gordon GP Gleadless Medical Centre Sheffield. michael.gordon@sheffield.ac.uk. Making life easier…. Dr Michael Gordon Primary Care Lead Yorkshire & The Humber Renal Network. Making life easier…. Dr Michael Gordon (emisWeb expert…not).

luann
Download Presentation

Making life easier…

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Making life easier… Dr Michael Gordon GP Gleadless Medical Centre Sheffield michael.gordon@sheffield.ac.uk

  2. Making life easier… Dr Michael Gordon Primary Care Lead Yorkshire & The Humber Renal Network

  3. Making life easier… Dr Michael Gordon (emisWeb expert…not)

  4. Making life easier… A Protocol for ACR interpretation

  5. ACR measurement fiddly but important • Measure albumin:creatinine ratio on a spot urine sample (preferably early morning) • If the initial ACR is >30 and <70 mg/mmol, confirm by a subsequent early morning sample. If the initial ACR is >70mg/mmol a repeat sample need not be tested • In people without diabetes, clinically significant proteinuria is present when ACR >30mg/mmol. • In people with diabetes microalbuminuria (ACR >2.5mg/ mmol in men and ACR >3.5mg/mmol in women) is clinically significant

  6. The Challenges • NICE output • QOF requirements • Remembering everything v knowing where to look • Getting excited about niche areas – e.g. CKD • Thinking hard when tired – Lab results.

  7. Proteinuria predicts progression of CKD RR of progression Urine protein excretion (g/day) Ann Intern Med 2003;139:244-252

  8. Proteinuria and CV mortality Muntner P et al JASN 2002;13:745

  9. CVD the big killer

  10. Traditional solution…The Wall Chart For • Brighten the room • Info at fingertips • Promotes humility Against • Clutter • Get lost • Undermine aura of omniscience • Gathering data to check

  11. When the ACR is 3 • What do you need to know about the patient to make sense of the result? • What else do you need to know to care for the patient optimally?

  12. Facts (Concepts) • Gender • Diabetic? • CKD already? • Latest and previous eGFR • Coded for microalbuminuria already • Previous ACR readings • BP – latest • BP – appropriate target • ACE/ARB use • ACE/ARB allergy

  13. emisWeb Protocols • Check the facts (concepts) • Follow user defined flowchart • End in user specified output • Applicable in a wide range of clinical situations

  14. emis Web protocols – building blocks • Concepts • Something asked of the recorded data • e.g. gender, Lastest BP < 140/90, coding present • Questions • Posed to the operator • e.g. has the patient got specific symptoms • Outputs • Guidance for the operator • e.g. a text box saying repeat in 1 year

  15. emisWeb protocols – construction process • Pencil, paper rubber • Build in emisWeb • Whiteboard, post-it notes, peer scrutiny • Attach to f12 key to run • Engage colleagues to test

  16. Mrs A • Type 2 Diabetes • Latest BP 140/82 • Not coded for microalbuminuria/proteinuria • No recent consultation with UTI symptoms • 2 previous ACRs > 3.5 • Allergic to ace/arb • Latest ACR - 3.6

  17. Mr B • Type 2 Diabetes • Latest eGFR 65 • Latest BP 129/79 • No recent symptoms of UTI • On Ramipril • Previous ACRs two > 2.5 • No microalbuminuria coded • Latest ACR - 25

  18. Mr C • Not diabetic • Last eGFR 45 • CKD stage 3 coded • Latest BP 120/78 • On Losartan • No UTI symptoms • Latest ACR - 35

  19. Ms D • Not diabetic • CKD stage 3 coded • Last eGFR 50 • Latest BP 130/80 • No UTI symptoms • Latest ACR - 50

  20. Acknowledgements • NHS Kidney Care – How to Guides • Hosting videos and protocol to download • Partners at Gleadless Medical

More Related