Abstract: TH-PO963

Improving Identification and Documentation of Urinary Tract Infection Risk after Renal Transplantation in Children

Session Information

Category: Transplantation

  • 1702 Transplantation: Clinical and Translational

Authors

  • Gaudreault-Tremblay, Marie-Michele, The Hospital for Sick Children, Toronto, Ontario, Canada
  • Noone, Damien Gerard, The Hospital for Sick Children, Toronto, Ontario, Canada
  • McQuillan, Rory F., University of Toronto, Toronto, Ontario, Canada
  • Hebert, Diane, The Hospital for Sick Children, Toronto, Ontario, Canada
  • Parekh, Rulan S., The Hospital For Sick Children, Toronto, Ontario, Canada
Background

Urinary tract infection (UTI) is the most frequent infectious complication after kidney transplantation in children. Trimethoprim-Sulfamethoxazole is standard UTI prophylaxis in all transplant recipients, irrespective of pre-transplant diagnosis or post-transplantation UTI risk factors. Identification and documentation of patient’s risk of post-transplantation UTI is often lacking, which complicates the choice of appropriate prophylaxis. The aim of this quality improvement project is to improve documentation and categorization of post-transplantation UTI risk for transplant recipients, with a target screening rate of 90%.

Methods

In our Centre, the model for improvement (Plan-Do-Study-Act) was used to sequentially implement an educational initiative and a checklist to facilitate systematic review of UTI history and risk factors. The purpose of the intervention was to allow clinicians to categorize children’s post-transplantation UTI risk. Documentation in patients’ medical records was assessed at each clinic visit. Parameters analyzed were: appropriate identification/documentation of post-transplantation UTI risk, UTI history and risk factors. The medical team satisfaction regarding the intervention and the supplementary time used to document was also assessed. A u chart was used for analysis.

Results

A total of 14 renal transplant outpatient clinics (77 patients; 126 medical visits) were reviewed from February to May 2017. The baseline documentation of UTI history in the patient’s medical record was 45% and of UTI risk factors 25%. After the medical team educational session, an increase of the documentation of UTI risk factors was observed (47% of documentation following educational session) but no significant change in documentation of UTI history (41%). Following implementation of the checklist, documentation of UTI history and risk factors improved by 21% and 17% respectively. However, categorization of patient’s post-transplantation UTI risk was almost always missing.

Conclusion

UTI is a major clinically significant complication following pediatric kidney transplantation. Implementation of a checklist significantly improved documentation of UTI history and risk factors in children after renal transplantation.