Domiciliary subcutaneous furosemide in patients with CKD and HF: a quality improvement project
Hospital admissions to treat fluid overload are common in patients with both heart failure and chronic kidney disease (CKD-HF). This is a population with high levels of frailty. Recurrent hospital admissions are costly to both patients and healthcare systems. We designed a proof-of-concept, multidis...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2025-04-01
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| Series: | BMJ Open Quality |
| Online Access: | https://bmjopenquality.bmj.com/content/14/2/e002984.full |
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| author | Laura Bijman Debasish Banerjee Lisa Anderson Nicholas M P Annear Giuseppe Rosano Irina Chis Ster Ella Tumelty Rosa Montero Ashwin Anenden Jane Nokes Vasa Gnanapragasam Mahrukh Ayesha Ali Sabba Hussain Isaac Chung Matthew Sunter Tristan Williams |
| author_facet | Laura Bijman Debasish Banerjee Lisa Anderson Nicholas M P Annear Giuseppe Rosano Irina Chis Ster Ella Tumelty Rosa Montero Ashwin Anenden Jane Nokes Vasa Gnanapragasam Mahrukh Ayesha Ali Sabba Hussain Isaac Chung Matthew Sunter Tristan Williams |
| author_sort | Laura Bijman |
| collection | DOAJ |
| description | Hospital admissions to treat fluid overload are common in patients with both heart failure and chronic kidney disease (CKD-HF). This is a population with high levels of frailty. Recurrent hospital admissions are costly to both patients and healthcare systems. We designed a proof-of-concept, multidisciplinary quality improvement project to deliver at-home subcutaneous furosemide to treat fluid overload in patients with CKD-HF. This project involved collaboration between a hospital, community remote monitoring hub and hospital-at-home team, including general practitioners, secondary care physicians, nurses and pharmacists. Patients were considered suitable for the intervention if they had CKD-HF, fluid overload and were haemodynamically stable. Following review, suitable patients were treated at-home with 80 mg subcutaneous furosemide over 5 hours, for 5 days. This was administered by the hospital-at-home team in liaison with hospital specialists, with continuous patient monitoring provided by the remote monitoring hub. Renal function and weight were assessed daily. Following treatment, patients were reviewed by the secondary-care team to adjust their maintenance medications. Data collected and analysed included daily weights, renal function and observations, as well as the number of hospitalisations and/or death at 30 days following the intervention. 10 patients successfully completed treatment. All potentially required hospitalisation at baseline and all avoided hospitalisation during the 5-day course of subcutaneous furosemide. One patient was admitted to the hospital following their final hospital review, and two patients were hospitalised for 4 and 14 days respectively, after their final dose of subcutaneous furosemide. Renal function and potassium did not significantly change throughout the treatment. No major safety concerns were identified. Patients welcomed the intervention. This quality improvement project demonstrates that it is logistically feasible, with primary care collaboration, to treat fluid overload in patients with CKD-HF at-home using subcutaneous furosemide. |
| format | Article |
| id | doaj-art-a38f26cd7f5446a48fdbbc79ba79e398 |
| institution | OA Journals |
| issn | 2399-6641 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Quality |
| spelling | doaj-art-a38f26cd7f5446a48fdbbc79ba79e3982025-08-20T02:34:39ZengBMJ Publishing GroupBMJ Open Quality2399-66412025-04-0114210.1136/bmjoq-2024-002984Domiciliary subcutaneous furosemide in patients with CKD and HF: a quality improvement projectLaura Bijman0Debasish Banerjee1Lisa Anderson2Nicholas M P Annear3Giuseppe Rosano4Irina Chis Ster5Ella Tumelty6Rosa Montero7Ashwin Anenden8Jane Nokes9Vasa Gnanapragasam10Mahrukh Ayesha Ali11Sabba Hussain12Isaac Chung13Matthew Sunter14Tristan Williams15St George’s University Hospitals NHS Foundation Trust, London, England, UKSchool of Health & Medical Sciences, St George’s University of London, London, London, UKCardivascular Sciences, St George’s University of London, London, UKSt George’s University Hospitals NHS Foundation Trust, London, England, UKSt George’s University Hospitals NHS Foundation Trust, London, England, UKSchool of Health & Medical Sciences, St George’s University of London, London, London, UKSt George’s University Hospitals NHS Foundation Trust, London, England, UKSt George’s University Hospitals NHS Foundation Trust, London, England, UKHospital At Home, London, UKCentral London Community Healthcare NHS Trust, London, London, UKNHS England London, London, UKSt George’s University Hospitals NHS Foundation Trust, London, England, UKSt George’s University Hospitals NHS Foundation Trust, London, England, UKSt George’s University Hospitals NHS Foundation Trust, London, England, UKSt George’s University Hospitals NHS Foundation Trust, London, England, UKSt George’s University Hospitals NHS Foundation Trust, London, England, UKHospital admissions to treat fluid overload are common in patients with both heart failure and chronic kidney disease (CKD-HF). This is a population with high levels of frailty. Recurrent hospital admissions are costly to both patients and healthcare systems. We designed a proof-of-concept, multidisciplinary quality improvement project to deliver at-home subcutaneous furosemide to treat fluid overload in patients with CKD-HF. This project involved collaboration between a hospital, community remote monitoring hub and hospital-at-home team, including general practitioners, secondary care physicians, nurses and pharmacists. Patients were considered suitable for the intervention if they had CKD-HF, fluid overload and were haemodynamically stable. Following review, suitable patients were treated at-home with 80 mg subcutaneous furosemide over 5 hours, for 5 days. This was administered by the hospital-at-home team in liaison with hospital specialists, with continuous patient monitoring provided by the remote monitoring hub. Renal function and weight were assessed daily. Following treatment, patients were reviewed by the secondary-care team to adjust their maintenance medications. Data collected and analysed included daily weights, renal function and observations, as well as the number of hospitalisations and/or death at 30 days following the intervention. 10 patients successfully completed treatment. All potentially required hospitalisation at baseline and all avoided hospitalisation during the 5-day course of subcutaneous furosemide. One patient was admitted to the hospital following their final hospital review, and two patients were hospitalised for 4 and 14 days respectively, after their final dose of subcutaneous furosemide. Renal function and potassium did not significantly change throughout the treatment. No major safety concerns were identified. Patients welcomed the intervention. This quality improvement project demonstrates that it is logistically feasible, with primary care collaboration, to treat fluid overload in patients with CKD-HF at-home using subcutaneous furosemide.https://bmjopenquality.bmj.com/content/14/2/e002984.full |
| spellingShingle | Laura Bijman Debasish Banerjee Lisa Anderson Nicholas M P Annear Giuseppe Rosano Irina Chis Ster Ella Tumelty Rosa Montero Ashwin Anenden Jane Nokes Vasa Gnanapragasam Mahrukh Ayesha Ali Sabba Hussain Isaac Chung Matthew Sunter Tristan Williams Domiciliary subcutaneous furosemide in patients with CKD and HF: a quality improvement project BMJ Open Quality |
| title | Domiciliary subcutaneous furosemide in patients with CKD and HF: a quality improvement project |
| title_full | Domiciliary subcutaneous furosemide in patients with CKD and HF: a quality improvement project |
| title_fullStr | Domiciliary subcutaneous furosemide in patients with CKD and HF: a quality improvement project |
| title_full_unstemmed | Domiciliary subcutaneous furosemide in patients with CKD and HF: a quality improvement project |
| title_short | Domiciliary subcutaneous furosemide in patients with CKD and HF: a quality improvement project |
| title_sort | domiciliary subcutaneous furosemide in patients with ckd and hf a quality improvement project |
| url | https://bmjopenquality.bmj.com/content/14/2/e002984.full |
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