Reducing acute kidney injury in pediatric oncology patients: An improvement project targeting nephrotoxic medications

Area of Science:

• Pediatric Nephrology
• Hospital Quality Improvement
• Oncology Patient Care

Background:

• Nephrotoxic medication exposure and acute kidney injury (AKI) are common in hospitalized children.
• Cincinnati Children's Hospital Medical Center initiated a project to raise awareness and reduce AKI.
• The oncology service used data for a quality improvement project targeting AKI reduction.

Purpose of the Study:

• To decrease the incidence of nephrotoxic medication exposure in hospitalized pediatric oncology patients.
• To reduce the occurrence of acute kidney injury (AKI) associated with nephrotoxic medications.
• To implement and evaluate targeted interventions within an oncology service.

Main Methods:

• Implemented three interventions: cefepime replacing piperacillin-tazobactam, vancomycin stewardship limiting courses to 72 hours, and standardized nephroprotection for IV contrast.
• Focused on noncritically ill patient days within the oncology service.
• Utilized a quality improvement framework to drive changes.

Main Results:

• Nephrotoxic medication exposure decreased by 49% (from 16.08 to 8.17 per 1000 patient days).
• Acute kidney injury (AKI) episodes associated with nephrotoxic exposure decreased by 45% (from 3.48 to 1.92 per 1000 patient days).
• The study included 42,520 noncritically ill patient days and 273 unique patients exposed to combination nephrotoxic medications.

Conclusions:

• A three-pronged approach effectively reduced nephrotoxic medication exposure and associated AKI in hospitalized oncology patients.
• The quality improvement initiative demonstrated success in improving patient safety.
• Targeted interventions can significantly lower AKI rates in vulnerable pediatric populations.