Graeme Turner

Summer is approaching and that means dehydration and gastroenteritis may affect some elderly patients or patients with multiple comorbidities. To help them self-manage their care and to prevent possible hospitalisation a Sick Day Action Plan (SDAP) can (and should) be implemented. 

A SDAP supports the patient to temporarily suspend medications, such as metformin, diuretics, SGLT2 inhibitors, ACEis and ARBs when there is a risk of hypovolemia. The patient should stop taking these medications for 24 to 48 hours andshould also contact their GP for further advice and treatment.

The SDAP should be developed in collaboration with the patient and the “teach back” technique is a useful method in this situation to make sure that the patient understands what is being implemented. The HealthPathways website has some SDAP templates that can be used to guide the health professional when prescribing  a SDAP.

Patients with diabetes, cardiac failure, cancer and pre-existing reduced kidney function are all at risk of developing an Acute Kidney Injury (AKI). This is characterized by a rapid reduction in kidney function and is associated with longer lengths of stay in hospitals and the increased requirement for Renal Replacement Therapy (RRT). Prevention is the key to avoiding AKIs and this can be done in primary care through the use of SDAPs.

In the Clarence/Richmond area of the Northern NSW Local Health District, Graeme Turner, Nurse Practitioner – Chronic Kidney Disease (CKD), has been working with general practices for over 10 years to implement SDAPs and educate practice teams about maintaining healthy kidneys. Due to the success of this work the Tweed/Byron area has employed a Transitional Nurse Practitioner (TNP) – Chronic Kidney Disease to replicate this service in their region.

Kylie Wyndham is the CKD–TNP for the Tweed Byron Network. She comes from a general practice background and is passionate about preventing the complications of chronic disease. Both Graeme and Kylie are available to help assist general practices in the implementation of SDAPs. This can be through staff education or through direct referral for patients with known CKD or indicators of CKD. The referral process for both are below. 

There is evidence that Sick Day Action Plans reduce hospitalisation and support patients to self-manage their care. Those at greatest risk are the elderly and patients with comorbidities. 

By using HealthPathways templates, together with assistance from the CKD specialist nurses, GPs can reduce the incidence, morbidity and mortality of acute kidney injury.