Recognising and preventing acute kidney injury

An elderly lady calls into her local community pharmacy to buy some loperamide. She introduces herself as Sylvia and tells the medicines counter assistant that she has had diarrhoea for the past 24 hours and hasn't been eating or drinking very well. Since the pharmacist has asked his team to highlight older people who may be dehydrated, the medicines counter assistant refers this case to the pharmacy technician who notes from the dispensing records that the patient is taking lisinopril 20mg daily for hypertension. The pharmacy technician follows the advice she has been given and consults the pharmacist, who decides to speak to Sylvia about her risk of acute kidney injury.

This community pharmacy team has set up a good system for identifying patients at risk of acute kidney injury which you might wish to consider implementing. Throughout the team, red flag alerts have been put in place to highlight the triggers that are putting patients at risk of acute kidney injury.

The patient calls back to the pharmacy the following week for a repeat prescription of her medicines and tells the pharmacist that her diarrhoea recovered within a couple of days and that she then started taking her lisinopril again. She explains that she will use the advice the pharmacy team members have given her about the health of her kidneys and withholding her medicines if she becomes dehydrated in the future and thanks them for all their help and advice. The pharmacist was able to highlight this case to his team as an example of where they may have prevented acute kidney injury.