51. A prospective multi-center quality improvement initiative (NINJA) indicates a reduction in nephrotoxic acute kidney injury in hospitalized children
- Author
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Stephen E. Muething, Valerie Bica, Joann Mooney, Richard K. Ogden, Theresa Mottes, Jordan M. Symons, Karyn Yonekawa, Kathleen E. Walsh, Jessica Kerr, Fang Zhang, Heather C. Kaplan, Julia Steinke, Jason Misurac, Joshua J. Zaritsky, Bradley A. Warady, Eric S. Kirkendall, Lynn Dill, Patrick D. Brophy, David J. Askenazi, Patricia L. Weng, Richard Hackbarth, Stuart L. Goldstein, Michael J. Somers, Sara L Ogrin, Shina Menon, Wendy Hoebing, Lisa Abrams, Jennifer A. Gilarde, Traci Henderson, Scott M. Sutherland, Devesh Dahale, and Vimal Chadha
- Subjects
0301 basic medicine ,medicine.medical_specialty ,Hospitalized patients ,030232 urology & nephrology ,Single Center ,Nephrotoxicity ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Primary outcome ,medicine ,Humans ,Prospective Studies ,Child ,Creatinine ,business.industry ,Acute kidney injury ,Acute Kidney Injury ,medicine.disease ,Quality Improvement ,030104 developmental biology ,chemistry ,Nephrology ,Emergency medicine ,business ,Child, Hospitalized ,Serum creatinine level ,Kidney disease - Abstract
Nephrotoxic medication (NTMx) exposure is a common cause of acute kidney injury (AKI) in hospitalized children. The Nephrotoxic Injury Negated by Just-in time Action (NINJA) program decreased NTMx associated AKI (NTMx-AKI) by 62% at one center. To further test the program, we incorporated NINJA across nine centers with the goal of reducing NTMx exposure and, consequently, AKI rates across these centers. NINJA screens all non-critically ill hospitalized patients for high NTMx exposure (over three medications on the same day or an intravenous aminoglycoside over three consecutive days), and then recommends obtaining a daily serum creatinine level in exposed patients for the duration of, and two days after, exposure ending. Additionally, substitution of equally efficacious but less nephrotoxic medications for exposed patients starting the day of exposure was recommended when possible. The main outcome was AKI as defined by the Kidney Disease Improving Global Outcomes (KDIGO) serum creatinine criteria (increase of 50% or 0.3 mg/dl over baseline). The primary outcome measure was AKI episodes per 1000 patient-days. Improvement was defined by statistical process control methodology and confirmed by Autoregressive Integrated Moving Average (ARIMA) modeling. Eight consecutive bi-weekly measure rates in the same direction from the established baseline qualified as special cause change for special process control. We observed a significant and sustained 23.8% decrease in NTMx-AKI rates by statistical process control analysis and by ARIMA modeling; similar to those of the pilot single center. Thus, we have successfully applied the NINJA program to multiple pediatric institutions yielding decreased AKI rates.
- Published
- 2019