Electronic health record identification of nephrotoxin exposure and associated acute kidney injury
| Autor: | Hovi Nguyen, Cynthia A. Barclay, Carole Lannon, Anne Lesko, Natalie Foertmeyer, Michael Seid, Tracey M. Bracke, John C. Bucuvalas, Joshua K. Schaffzin, Eric S. Kirkendall, Stephen E. Muething, Marshall Ashby, Stuart L. Goldstein, Lori Brunner |
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| Rok vydání: | 2013 |
| Předmět: |
medicine.medical_specialty
Prescription Drugs Iatrogenic Disease Renal function Disease urologic and male genital diseases Kidney Function Tests Nephrotoxicity chemistry.chemical_compound Electronic health record Risk Factors Pediatric hospital medicine Electronic Health Records Humans Mass Screening Prospective Studies Intensive care medicine Infusions Intravenous Ohio Creatinine Academic Medical Centers business.industry Acute kidney injury Acute Kidney Injury medicine.disease Hospitals Pediatric Aminoglycosides Cross-Sectional Studies Trigger tool chemistry Pediatrics Perinatology and Child Health Emergency medicine business Pharmacy Service Hospital Algorithms |
| Zdroj: | Pediatrics. 132(3) |
| ISSN: | 1098-4275 |
| Popis: | BACKGROUND AND OBJECTIVE: Nephrotoxic medication exposure represents a common cause of acute kidney injury (nephrotoxin-AKI) in hospitalized children. Systematic serum creatinine (SCr) screening has not been routinely performed in children receiving nephrotoxins, potentially leading to underestimating nephrotoxin-AKI rates. We aimed to accurately determine nephrotoxin exposure and nephrotoxin-AKI rates to drive appropriate interventions in non–critically ill hospitalized children. METHODS: We conducted a prospective quality improvement project implementing a systematic electronic health record (EHR) screening and decision support process (trigger) at a single quaternary pediatric hospital. Patients were all noncritically ill hospitalized children receiving an intravenous aminoglycoside for ≥3 days or ≥3 nephrotoxins simultaneously (exposure). Pharmacists recommended daily SCr monitoring in exposed patients. AKI was defined by the modified pediatric Risk, Injury, Failure, Loss and End-stage Renal Disease criteria (≥25% decrease in estimated creatinine clearance). We developed 4 novel metrics: exposure rate per 1000 patient-days, AKI rate per 1000 patient-days, AKI rate (%) per high nephrotoxin admission, and AKI days per 100 exposure days (AKI intensity). RESULTS: This study included 21 807 patients accounting for 27 711 admissions. A total of 726 (3.3%) unique exposed patients accounted for 945 hospital admissions (6713 patient-days). AKI occurred in 25% of unique exposed patients and 31% of exposure admissions (1974 patient-days). Our EHR-driven SCr nephrotoxin-AKI surveillance process was associated with a 42% reduction in AKI intensity. CONCLUSIONS: Nephrotoxin-AKI rates are high in noncritically ill children; systematic screening for nephrotoxic medication exposure and AKI detection was accomplished reliably through an EHR based trigger tool. |
| Databáze: | OpenAIRE |
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