Journal article
A prospective multi-center quality improvement initiative (NINJA) indicates a reduction in nephrotoxic acute kidney injury in hospitalized children
Kidney international, Vol.97(3), pp.580-588
03/2020
DOI: 10.1016/j.kint.2019.10.015
PMID: 31980139
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.
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Details
- Title: Subtitle
- A prospective multi-center quality improvement initiative (NINJA) indicates a reduction in nephrotoxic acute kidney injury in hospitalized children
- Creators
- Stuart L. Goldstein - Cincinnati Children's Hospital Medical CenterDevesh Dahale - Cincinnati Children's Hospital Medical CenterEric S. Kirkendall - Cincinnati Children's Hospital Medical CenterTheresa Mottes - Cincinnati Children's Hospital Medical CenterHeather Kaplan - Cincinnati Children's Hospital Medical CenterStephen Muething - Cincinnati Children's Hospital Medical CenterDavid J. Askenazi - Children's of AlabamaTraci Henderson - Children's of AlabamaLynn Dill - Children's of AlabamaMichael J.G. Somers - Boston Children's HospitalJessica Kerr - Boston Children's HospitalJennifer Gilarde - Boston Children's HospitalJoshua Zaritsky - Dupont HospitalValerie Bica - Dupont HospitalPatrick D. Brophy - Division of Nephrology, Stead Family Children’s Hospital, Iowa City, Iowa, USAJason Misurac - Division of Nephrology, Stead Family Children’s Hospital, Iowa City, Iowa, USARichard Hackbarth - Helen DeVos Children's HospitalJulia Steinke - Helen DeVos Children's HospitalJoann Mooney - Helen DeVos Children's HospitalSara Ogrin - Helen DeVos Children's HospitalVimal Chadha - Children's Mercy HospitalBradley Warady - Children's Mercy HospitalRichard Ogden - Children's Mercy HospitalWendy Hoebing - Children's Mercy HospitalJordan Symons - Seattle Children's HospitalKaryn Yonekawa - Seattle Children's HospitalShina Menon - Seattle Children's HospitalLisa Abrams - Seattle Children's HospitalScott Sutherland - Lucile Packard Children's HospitalPatricia Weng - Mattel Children's HospitalFang Zhang - Harvard Pilgrim Health CareKathleen Walsh - Cincinnati Children's Hospital Medical Center
- Resource Type
- Journal article
- Publication Details
- Kidney international, Vol.97(3), pp.580-588
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.kint.2019.10.015
- PMID
- 31980139
- ISSN
- 0085-2538
- eISSN
- 1523-1755
- Grant note
- DOI: 10.13039/100000133, name: Agency for Healthcare Research and Quality
- Language
- English
- Date published
- 03/2020
- Academic Unit
- Nephrology, Dialysis and Transplantation; Stead Family Department of Pediatrics
- Record Identifier
- 9984353841902771
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