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Reducing Acute Kidney Injury in Critically Ill Pediatric Patients: Quality Improvement Project Targeting Nephrotoxic
Natalie Capretta1, Diana Zepeda-Orozco2,3,4, W Joshua Frazier1
1Division of Critical Care Medicine, Nationwide Children's Hospital, Columbus, OH.
Summary
A quality improvement initiative reduced acute kidney injury (AKI) in critically ill children exposed to nephrotoxic medications (NTM). Pharmacist-led education and daily alerts significantly lowered NTM exposure and NAKI rates.
Area of Science:
- Pediatric Critical Care Medicine
- Nephrology
- Quality Improvement Science
Background:
- Nephrotoxic medications (NTM) are a significant risk factor for acute kidney injury (AKI) in critically ill pediatric patients.
- Structured interventions are needed to mitigate NTM-associated AKI (NAKI) in the pediatric intensive care unit (PICU).
Purpose of the Study:
- To decrease the incidence of AKI resulting from nephrotoxic medication exposure in critically ill children.
- To implement and evaluate a quality improvement (QI) initiative targeting NTM use in the PICU.
Main Methods:
- A prospective, multi-phased QI project was conducted at a quaternary care children's hospital.
- Interventions included pharmacist-led education, informational handouts, and daily clinical pharmacist notifications of NTM exposure.
- Data on NTM exposure and NAKI rates were collected pre- and post-intervention.
Main Results:
- NTM exposure rates decreased by 12.4% (30.6 to 26.9 per 1000 patient-days).
- NTM-associated AKI (NAKI) rates saw a significant reduction of 55% (5.6 to 2.5 per 1000 patient-days).
- The study included 34,631 patient-days over a 20-month period.
Conclusions:
- Targeted QI interventions, including education and pharmacy alerts, effectively reduced NTM exposure and NAKI in critically ill pediatric patients.
- Pharmacy-driven notifications and stakeholder education are key components for NTM stewardship.
- Ongoing efforts focus on institutional integration and sustainability of these successful strategies.
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