Assistant Professor, Department of Nephrology Ann & Robert H. Lurie Children's Hospital of Chicago Chicago, Illinois, United States
Background: Nephrotoxic medication exposure continues to be one of the leading causes of Acute Kidney Injury (AKI) in hospitalized patients. To mitigate the rates and resulting morbidity of Nephrotoxic AKI (NAKI), a multi-center initiative with universal NAKI definitions and medication triggers has been implemented and validated using the Electronic Medical Record. At our institution, this has led to improvement in both NAKI exposure and event rates in certain service lines. Objective: To attain further NAKI Event reduction, we implemented a Focused Event Review Survey (FERS) to determine etiology of NAKI events as well as to identify measures to improve outcomes. Design/Methods: A FERS (Figure 1-2) was designed through a multidisciplinary team (physicians, nurses, advanced practice providers, and pharmacists) and sent via Redcap to the attending physician of record at the time of each NAKI Event from March 2023-September 2023. Objective survey data was pre-filled by a NAKI core team member. Based on the data collected from the FERS, the NAKI Core Team classified the event as unavoidable versus potentially avoidable. Results: FERS were conducted for 87 NAKI Events that occurred at our single center. The response rate was 31% (27/87). The NAKI Core Team classified 7/27 (26%) events as potentially avoidable (Figure 3). From a provider perspective, providers believed that an equally efficacious medication was available 7.2% of the time and believed NAKI events were avoidable 7.4% of the time. 1/7 of the potentially avoidable events resulted in KDIGO Stage 3 AKI.
Conclusion(s): A FER survey can be used to determine potentially avoidable NAKI Events. Targeted areas of intervention at our single center include educating clinicians about nephrotoxic medications, antibiotic stewardship, and continued emphasis on NSAID avoidance in high-risk patients. Limitations include determination of “potentially avoidable” event based on the discretion of the NAKI core team.
