4CPS-176 Niki-tag (nephrotoxic injury in kids-tag): screening of paediatric hospitalised patients exposed to nephrotoxic drugs and education for reducing the risk of acute kidney injury

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Background and Importance Exposure to nephrotoxic drugs is the first cause of acute kidney injury (AKI) in paediatric patients and is associated with increased morbidity, cost and length of stay. Using clinical decision support systems (CDSS), for the electronic screening of patients exposed to the risk of AKI, associated to education may reduce nephrotoxic drugs-associated AKI. Aim and Objectives To evaluate the impact of a quality improvement programme including electronic screening of nephrotoxic drugs prescriptions with CDSS and an educational programme for medical and nursing staff on the occurrence of AKI in paediatric patients. Material and Methods CDSS detected the ‘prescription of ≥2 nephrotoxic drugs on the same day’ and/or ‘a nephrotoxic IV drug administration >72h’ from health records in paediatric patients (0–18 years). AKI was diagnosed according to KDIGO definition. Non-intervention (NoINT, 14 months) was followed by education on drug nephrotoxicity (2 months, including microlearning, pocket card, and 30-min interactive workshops) and intervention (INT, 11 months, phone call by a paediatric nephrologist to the prescriber to make recommendations on AKI detection or management). The positive predictive value (PPV) for the alerts (i.e., the proportion of alerts that led to an intervention), the occurrence (Chi2) and the risk of AKI (hazard ratio HR (95% CI) adjusted for age, ward, type of alert, presence of chronic kidney disease) were calculated. Results 168 participants followed the microlearning, and workshops were attended by 39 physicians and 84 nurses. Alerts were identified in 5.2% (555/10,698; NoINT:285 alerts, INT:270) of hospitalised paediatric patients (mean age±SD: 6.5±6.2 vs 5.7±5.6, p>0.05). The main trigger alert was related to the prescription of ≥2 nephrotoxic drugs (64%), mainly antibiotics (35%) and NSAIDs (21%). PPV was 39.3% (106 interventions for 270 alerts). AKI occurrence was significantly reduced after education and intervention (NoINT: 22.5% of alerts (64/285) vs INT: 11.9% (32/270), p=0.001). A reduction by 46% in the incidence of AKI was determined after adjustment for confounding factors (HR 0.54; 95% CI 0.33–0.87, p=0.011). Conclusion and Relevance Occurrence and risk of nephrotoxic drugs-associated AKI was significantly reduced by 46% in hospitalised paediatric patients with the implementation of a quality improvement programme including electronic screening and education. Screening of high-risk patients and intervention to prescribing physicians will be taken over by clinical pharmacists. References and/or Acknowledgements Conflict of Interest No conflict of interest

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