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Decreases in Nephrotoxic Pain Medications Are Not Associated With Increased Opioid Utilization in Critically Ill
Erin K Stenson1, Gina DeMasellis1, Ananya Shah2
1Section of Pediatric Critical Care, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO.
Insights
A quality improvement initiative successfully reduced nephrotoxic medication exposure in critically ill children. This program also decreased opioid and benzodiazepine use without increasing acute kidney injury (AKI) rates.
Area of Science:
- Pediatric critical care medicine
- Quality improvement science
- Nephrology
Background:
- Quality improvement initiatives have successfully reduced nephrotoxic medication exposure and acute kidney injury (AKI) in non-critically ill children.
- The impact of such initiatives on critically ill pediatric populations, particularly concerning nephrotoxic medication exposure and associated risks, requires further investigation.
Purpose of the Study:
- To analyze the implementation of a quality improvement program targeting nephrotoxic medication exposure in critically ill children.
- To measure the program's effect on nephrotoxic medication exposure, acute kidney injury (AKI) rates, and concurrent opioid and benzodiazepine exposure.
Main Methods:
- Prospective quality improvement study conducted in a Pediatric Intensive Care Unit (PICU) from 2018 to 2020.
- Inclusion of all children admitted to the PICU.
- Implementation of the Nephrotoxic Injury Negated by Just-In-Time Action (NINJA) quality improvement initiative.
Main Results:
- A total of 8,833 PICU patient admissions were analyzed.
- Mean rates of nephrotoxic medication exposure decreased significantly from 46 to 26 per 1,000 PICU patient days.
- Rates of nephrotoxic AKI per 1,000 PICU patient days remained unchanged, while nonsteroidal anti-inflammatory drug, opioid, and benzodiazepine exposures were also reduced.
Conclusions:
- The NINJA intervention was effectively implemented in the single-center PICU.
- Nephrotoxic medication exposure is a modifiable factor in critically ill children.
- The intervention successfully reduced nephrotoxic exposure without inadvertently increasing opioid and benzodiazepine exposure.
Objectives:
Quality improvement initiatives to decrease rates of nephrotoxic medication exposure have reduced rates of acute kidney injury (AKI) in noncritically ill children. The objective of our study was to analyze the implementation of a similar program in critically ill children and to measure important balancing measures including opioid and benzodiazepine exposure.
Design:
Prospective quality improvement study.
Setting:
PICU at Children's Hospital Colorado between 2018 and 2020.
Patients:
All children admitted to PICU.
Interventions:
Quality improvement initiative called Nephrotoxic Injury Negated by Just-In-Time Action (NINJA).
Measurement And Main Results:
Eight thousand eight hundred thirty-three PICU patient admissions were included. Mean rates of nephrotoxic medication exposure/1,000 PICU patient days decreased from 46 to 26, whereas rates of nephrotoxic AKI/1,000 PICU patient days did not change. Nonsteroidal anti-inflammatory drug dispenses per 1,000 patient days were reduced from 521 to 456. Similarly, opioid and benzodiazepine exposures per 1,000 patient days were reduced from 812 to 524 and 441 to 227, respectively, during the study observation period.
Conclusions:
The NINJA intervention was efficaciously implemented in our single-center PICU. Nephrotoxic exposure is a modifiable factor that did not inadvertently increase exposure to opioids and benzodiazepines.
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