Pediatric Nephrology Fellow Children's National Hospital Washington, District of Columbia, United States
Background: As we develop our institution’s acute kidney support therapy program and introduce new acute dialysis modalities, it is imperative to standardize our practices to provide optimized, equitable care. Objective: We aim to reduce variability in prescribing acute renal replacement therapy and limit blood product exposure in patients receiving these therapies. Design/Methods: IRB approval was waived as per institutional guidelines for quality improvement. The key drivers for improvement included the need for guidelines, standardized education, and introduction of new modalities. Baseline data was gathered from continuous renal replacement therapy (CRRT) circuit initiations two years prior to the project implementation. Our first Plan-Do-Study-Act (PDSA) cycle began in May 2023 with establishing guidelines with recommendations for modalities and CRRT prescriptions. An AKI curriculum was developed involving critical care medicine and nephrology with inter-departmental didactics reinforcing concepts for trainees, nursing, and faculty. Modified aquapheresis was subsequently introduced in August. A CRRT prescription tool was programmed to determine ideal dialysis catheter size, filter choice, flow rates and effluent dosing. Once validated, providers began using it in September. Data from all CRRT circuits will be collected prospectively. At the end of November, we will review and analyze data from the last three months after the changes were implemented. Frequency of blood priming and site of citrate infusion will be analyzed as binary variables. Variation in blood flow rates, effluent dosing, and replacement fluid rates based on age and size will be analyzed. Further PDSA cycle interventions include adjustments to guidelines and the prescription tool, education/competency assessment, new modalities/therapies, and updates to the electrolytic medical record. Interventions will be implemented based on ongoing review of data every three months.
