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Quality Improvement Bedside Rounding Audits Enhance Protein Provision for Pediatric Patients Receiving Continuous Renal Replacement Therapy*

Vega, Molly Wong, MS, RDN1; Juarez, Marisa, MPH, RDN1; Lee, Ji Yeon, PharmD, BCPPS1; Srivaths, Poyyapakkam, MD1; Williams, Eric, MD, MS2; Akcan Arikan, Ayse, MD1,2

doi: 10.1097/PCC.0000000000001698
Quality and Safety

Objectives: Describe quality improvement process improvements in protein delivery of continuous renal replacement therapy initiation.

Design: Prospective study.

Setting: PICU and cardiovascular ICU within a quaternary care children’s hospital.

Patients: PICU and cardiovascular ICU patients receiving continuous renal replacement therapy for greater than 48 hours. Inborn errors of metabolism were excluded.

Interventions: Plan-Do-Study-Act cycles were initiated. Cycle 1 developed interdisciplinary quality improvement group continuously monitoring nutrition care with thrice weekly bedside safety rounds and protein prescriptions within nephrologist’s notes. Cycle 2 included education to intensivists. Cycle 3 initiated monthly quality improvement meetings reviewing nutritional care goals.

Measurements and Main Results: Primary outcome was percentage of time patients met protein goals in the first 5 days of continuous renal replacement therapy. Secondary outcome was percentage of time patients met protein goals for duration of continuous renal replacement therapy. Cohort (n = 55) mean age was 8.1 years (SD ± 6.8), 62% male, and 31% malnutrition at baseline. Percent of time meeting protein goals by day 5 was 22%, 33%, and 71% and percent of time meeting protein goals throughout was 35%, 39%, and 75% of groups 1, 2, and 3, respectively. Significant improvement occurred after Plan-Do-Study-Act 3 (group 2 vs group 3; p < 0.01) for primary and secondary outcomes.

Conclusions: Implementation of an interprofessional quality improvement team significantly decreased number of continuous renal replacement therapy days with unmet protein goals and improved protein delivery.

1Section of Nephrology, Department of Pediatrics, Baylor College of Medicine, Houston, TX.

2Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX.

*See also p. 1087.

Ms. Juarez disclosed that her husband works for Baxter. Dr. Akcan Arikan’s institution received funding from Baxter. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: mrvega@texaschildrens.org

©2018The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies