Abstract: SA-PO095

Continuous Renal Replacement Therapy Dosing in Critically Ill Patients

Session Information

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Griffin, Benjamin, University of Colorado, Aurora, Colorado, United States
  • Thomson, Amanda, University of Colorado Hospital, Aurora, Colorado, United States
  • Yoder, Mark, UCHealth, Aurora, Colorado, United States
  • Bortolotto, Shannon Johnson, Univeristy of Colorado Hospital/UCHealth, Aurora, Colorado, United States
  • Bonnes, Deb G, UCHealth, Aurora, Colorado, United States
  • Dufficy, Lisa M, University of Colorado Hospital, Aurora, Colorado, United States
  • Bregman, Adam Philip, None, Denver, Colorado, United States
  • Faubel, Sarah, University of Colorado Denver, Denver, Colorado, United States
  • Jalal, Diana I., University of Colorado Denver Health Science Center, Aurora, Colorado, United States
Background

Continuous Renal Replacement Therapy (CRRT) is a commonly performed procedure in critically ill patients with acute kidney injury (AKI) in the intensive care unit (ICU). National guidelines from Kidney Disease Improving Global Outcomes (KDIGO) give a level 1A recommendation that CRRT should be prescribed to achieve a daily dose of 20-25 ml/kg/hr. Unfortunately, nationwide prescribing practices are quite variable, including among renal staff at the University of Colorado Hospital (UCH).

Methods

Our aim was to deliver a 20-25 mL/kg/hr average daily dose of CRRT in >80% of daily sessions. All patients at UCH who received CRRT were included. Key interventions included modifications to the CRRT flowsheet in EPIC to display actual delivered dose in terms of mL/kg/hr, development of a “CRRT Provider Protocol” to standardize CRRT delivery across the division, implementation of a CRRT didactic session within the clinical fellows’ core curriculum, and an update of the standard CRRT procedure note to include the 24-hour average delivered dose. The outcome variable was % of patients with CRRT dosing in the range of 20-25 mL/kg/hr. Process variables included % of CRRT hours charted correctly by the nursing staff, and % of nephrology notes that record the dose. Balancing measures included nursing satisfaction and time spent charting.

Results

The above implementations were employed starting in February 2017. Prior to then only 32% of patients had an average daily delivered CRRT dose in the range of 20-25 mL/kg/hr. The median value since implementation in 62% (Figure 1). Nurses accurately charted the dosing variables 87% of the time when the new flowsheet was implemented, which has since risen to 96% charting accuracy. 100% of nurses surveyed feel their workload is the same or less with the new flowsheet.

Conclusion

Achieving the KDIGO recommended guidelines of delivering CRRT at 20-25 mL/kg/hr is achievable using EMR tools, and does not significantly increase the workload for nephrologists or nursing staff.