Journal article
Continuous Renal Replacement Therapy Dosing in Critically III Patients: A Quality Improvement initiative
American journal of kidney diseases, Vol.74(6), pp.727-735
12/01/2019
DOI: 10.1053/j.ajkd.2019.06.013
PMCID: PMC6939344
PMID: 31540789
Abstract
Rationale & Objective: Clinical practice guide lines recommend delivering a continuous renal replacement therapy (CRRT) dose of 20 to 25 mL/kg/h. However, practice patterns nationwide are highly variable; this inconsistent prescribing may lead to errors in medication dosing and increase rates of electrolyte and acid-base abnormalities. We describe an initiative to standardize CRRT practice patterns and reduce dosing variability.
Study Design: Quality improvement study.
Setting & Participants: Adult patients treated with CRRT at the University of Colorado Hospital between January 2016 and October 2017.
Quality Improvement Activities: An assessment of the magnitude of the variability in CRRT dosing and the following specific interventions were implemented during the course of 1 year: (1) modification of the electronic medical record (EMR) to include calculated average 24-hour dose in real time, (2) modification of the CRRT procedure note to include comments on dosing, (3) modification of the CRRT order set to display calculations, and (4) yearly educational sessions for renal fellows outlining CRRT-specific dosing targets.
Outcomes: The primary outcome was weekly percentage of CRRT treatments with an average delivered daily dose of 20 to 25 mL/kg/h. Process and balancing outcomes included CRRT flowsheet accuracy, documentation of rates of delivered dose, and nursing satisfaction.
Analytical Approach: Rates of weekly CRRT dosing in compliance with national guidelines were determined and used to create run charts showing compliance rates before and after the quality improvement interventions.
Results: Among 837 treatments before the intervention, 279 (33%) daily CRRT sessions achieved an average dose of 20 to 25 mL/kg/h. Following implementation of interventions, 631 of 952 (66%) treatments achieved this goal. Week-to-week variation in dosing was significantly reduced.
Limitations: A single-center study generating data that may not be generalizable to institutions with different CRRT nursing models or different EMR systems.
Conclusions: Changes to the EMR and documentation templates and education of CRRT providers about dosing were associated with doubling of the rate of appropriate CRRT dosing and reduction in dosing variability.
Details
- Title: Subtitle
- Continuous Renal Replacement Therapy Dosing in Critically III Patients: A Quality Improvement initiative
- Creators
- Benjamin R. Griffin - University of Colorado Anschutz Medical CampusAmanda Thomson - University of Colorado HealthMark Yoder - University of Colorado HealthIsaiah Francis - Colorado School of Public HealthSophia Ambruso - University of Colorado Anschutz Medical CampusAdam Bregman - University of Colorado Anschutz Medical CampusMichelle Feller - University of Colorado HealthShannon Johnson-Bortolotto - University of Colorado HealthChristine King - University of Colorado HealthDeborah Bonnes - University of Colorado HealthLisa Dufficy - University of Colorado HealthChaorong Wu - University of IowaAnip Bansal - University of Colorado Anschutz Medical CampusDarlene Tad-Y - University of Colorado Anschutz Medical CampusSarah Faubel - University of Colorado Anschutz Medical CampusDiana Jalal - University of Iowa
- Resource Type
- Journal article
- Publication Details
- American journal of kidney diseases, Vol.74(6), pp.727-735
- DOI
- 10.1053/j.ajkd.2019.06.013
- PMID
- 31540789
- PMCID
- PMC6939344
- NLM abbreviation
- Am J Kidney Dis
- ISSN
- 0272-6386
- eISSN
- 1523-6838
- Publisher
- Elsevier
- Number of pages
- 9
- Grant note
- UL1TR002537 / National Institutes of Health; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA University of Iowa Clinical and Translational Science Award CEPSRF-2016001 / University of Colorado Clinical Effectiveness and Patient Safety Grant for Residents and Fellows (CEPS-RF) award T32 DK 007135 / National Research Service Award Institutional Predoctoral Training Grant (T32) T32DK007135 / NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK) UL1TR002537 / NATIONAL CENTER FOR ADVANCING TRANSLATIONAL SCIENCES; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Center for Advancing Translational Sciences (NCATS)
- Language
- English
- Date published
- 12/01/2019
- Academic Unit
- Nephrology; Internal Medicine
- Record Identifier
- 9984359810402771
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