A sustained quality improvement program reduces nephrotoxic medication-associated acute kidney injury
A sustained quality improvement program reduces nephrotoxic medication-associated acute kidney injury
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DOI：
10.1016/j.kint.2016.03.031
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发表时间：
2016-07-01
影响因子：
19.6
通讯作者：
Kirkendall, Eric S.
中科院分区：
文献类型：
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作者：
Goldstein, Stuart L.;Mottes, Theresa;Kirkendall, Eric S.
暴露于肾毒性药物是住院患者急性肾损伤（阿基）的最常见原因之一。在这里，我们进行了一个前瞻性的质量改进项目，在我们的四级儿科住院医院实施系统的电子健康记录筛选和决策支持过程（触发器）。合格患者为2011年9月至2015年3月期间接受静脉注射氨基糖苷类药物超过3天或同时接受3种以上肾毒素（暴露）的非危重住院儿童。Pharmacology建议在触发报告中出现后，对暴露患者进行每日血清肌酐监测，阿基由肾脏疾病改善全球结局阿基标准定义。共有1749例患者分别住院2358次，在此期间共确定了3243次肾毒素暴露事件，其中170例患者（9.7%）经历了2次或2次以上暴露。在43个月的研究期间，共发生了575起阿基事件。总体而言，暴露率降低38%（11.63-7.24次暴露/1000患者日），阿基发生率降低64%（2.96-1.06次发作/1000患者日）。假设没有我们的项目实施，初始基线暴露率将持续存在，我们估计避免了633次暴露和398次阿基发作。因此，系统监测肾毒性药物暴露和近实时阿基风险可以持续减少可避免的伤害。这些干预措施和结果可用于其他儿科和非儿科住院环境。
Exposure to nephrotoxic medication is among the most common causes of acute kidney injury (AKI) in hospitalized patients. Here we conducted a prospective quality improvement project implementing a systematic Electronic Health Record screening and decision support process (trigger) in our quaternary pediatric inpatient hospital. Eligible patients were noncritically ill hospitalized children receiving an intravenous aminoglycoside for more than 3 days or more than 3 nephrotoxins simultaneously (exposure) from September 2011 through March 2015. Pharmacists recommended daily serum creatinine monitoring in exposed patients after appearance on the trigger report and AKI was defined by the Kidney Disease Improving Global Outcomes AKI criteria. A total of 1749 patients accounted for 2358 separate hospital admissions during which a total of 3243 episodes of nephrotoxin exposure were identified with 170 patients (9.7%) experiencing 2 or more exposures. A total of 575 individual AKI episodes occurred over the 43-month study period. Overall, the exposure rate decreased by 38% (11.63-7.24 exposures/1000 patient days), and the AKI rate decreased by 64% (2.96-1.06 episodes/1000 patient days). Assuming initial baseline exposure rates would have persisted without our project implementation, we estimate 633 exposures and 398 AKI episodes were avoided. Thus, systematic surveillance for nephrotoxic medication exposure and near real-time AKI risk can lead to sustained reductions in avoidable harm. These interventions and outcomes are translatable to other pediatric and nonpediatric hospitalized settings.