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Abstract: TH-PO511

Reducing AKI in Critically Ill Pediatric Patients: An Improvement Project Targeting Nephrotoxic Medication Exposures

Session Information

  • Pediatric Nephrology - I
    November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1900 Pediatric Nephrology

Authors

  • Capretta, Natalie R., Nationwide Children's Hospital, Columbus, Ohio, United States
  • Frazier, W. Joshua, Nationwide Children's Hospital, Columbus, Ohio, United States
  • Lutmer, Jeffrey, Nationwide Children's Hospital, Columbus, Ohio, United States
  • Sargel, Cheryl, Nationwide Children's Hospital, Columbus, Ohio, United States
  • Kalata, Lindsay, Nationwide Children's Hospital, Columbus, Ohio, United States
  • Gajarski, Robert J., Nationwide Children's Hospital, Columbus, Ohio, United States
  • Zepeda-Orozco, Diana, Nationwide Children's Hospital, Columbus, Ohio, United States
Background

Acute kidney injury (AKI) occurs commonly in critically ill hospitalized pediatric patients, is associated with nephrotoxic medication exposure and is independently associated with worse clinical outcomes. Our pediatric intensive care unit (PICU) utilized the multicenter Nephrotoxic AKI (NAKI) quality improvement project to increase awareness of nephrotoxic medication exposures, develop interventions, and reduce NAKI.

Methods

A multi-phased approach was used to increase education and recognition surrounding nephrotoxic medication exposures in the PICU and their role in subsequent AKI. Monthly resident physician education was provided by our unit-based clinical pharmacist, and an informational handout was created and reviewed monthly during resident PICU orientation. A third phase included a clinical pharmacist notification to attending physicians of patients meeting exposure criteria with acceptable alternatives to nephrotoxic drugs and suggestions for AKI monitoring.

Results

Our cohort included 39,181 patient days admitted to the PICU at our institution between October 1st 2022 and April 30th 2023. A total of 225 unique patients met nephrotoxic exposure criteria leading to 21 AKI episodes. We reduced nephrotoxic medication exposure rates by 25% from 36.73 to 27.39 per 1000 patient days and NAKIs by 51% from 5.43 to 2.64 per 1000 patient days.

Conclusion

Interventions to decrease AKI successfully in critically ill patients required a multi-phased approach including recurrent education efforts and pharmacy-driven daily physician alerts. Organizational implementation of these interventions is ongoing.