Use of implementation frameworks to guide development and adoption of a nephrotoxin stewardship service in high-risk...

To describe implementation strategies for a nephrotoxin stewardship service at Howard University Hospital aimed at reducing drug-associated acute kidney disease (D-AKD) in high-risk inpatients, as guided by the Consolidated Framework for Implementation Research (CFIR) and the Capability, Opportunity, Motivation - Behavior (COM-B) behavior change model.

D-AKD remains a prevalent and potentially preventable complication, particularly in patients exposed to multiple nephrotoxic drugs. Although clinical guidelines and evidence-based strategies for reducing D-AKD exist, implementation remains inconsistent in practice. We developed a nephrotoxin stewardship service using the CFIR and COM-B as guiding frameworks to address barriers and promote behavior change amongst clinicians. The program leveraged clinical decision support tools, pharmacist-led interventions, and multidisciplinary engagement to optimize medication safety. To assess impact and feasibility, we applied the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Lessons learned include the importance of leadership support, ongoing physician education, and iterative refinement of alerting systems. Future directions include outcome tracking to assess the incidence of acute kidney injury (AKI) post service initiation.

Our experience highlights how implementation science frameworks can facilitate the systematic development and integration of a nephrotoxin stewardship program within a complex hospital environment. As hospitals prioritize medication safety, our approach provides a scalable model for preventing AKI in high-risk populations. Ongoing evaluation and refinement will be key in ensuring sustained clinical benefit and broader dissemination.