1302 / Improved Nephroprotection against iodinated contrast agents

SPAIN
Classification of the PSP
Type of Patient Safety Practice Safe
 
Clinical Practice (CP)
Related practices from PaSQ database
"Best fit" category of the reported practice
Medical devices / Equipment
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Topic of the reported practice
Clinical risk management
Aim and the benefit of the Patient Safety Practice
 
One of the side effects of iodinated contrast agents is that it may aggravate the function of the kidney. Prophylaxis guidelines advise the use of bicarbonate solutions or hydration in case of an event.
Description of the Patient Safety Practice
 
Object Improving the implementation of protocol nephroprotection to intravenous iodinated contrast agents for patients with renal insufficiency in the Emergency Department (ED). Methods: In 2013, all emergency requests for the months of February and March were reviewed, selecting those cases where intravenous iodinated contrast media were used. Since January it was available at the emergency department a nephroprotection protocol, and its application was assessed. As data for the source the radiology file, emergency file, SELENE file and in patients admitted the clinical history were used. After the results, the protocol was adapted, and disseminated in the Emergency Department and, a year later, patients in the same period were evaluated. To evaluate the statistical significance of differences of compliance was used Chi-squared test. Results: The sample was 68 patients in 2013 and 66 in 2014. In the first sample, 19 cases (27.9%) presented elevated creatinine. From these, 12 (63.2%) received hydration. Two patients without renal failure received erroneously IV acetylcysteine and one bicarbonate. The percentage of overall compliance with the protocol was 85.3%. In 2014, only 7 had renal failure. Of these, 4 cases were premedicated with soda and 2 with hydration. Only one patient did not receive premedication, it is noteworthy that although presented creatinine levels of 1.3 there wer not sufficient data in the medical history (patient weight) to determine the creatinine clearance, and it was seen as failure. No patient with renal insufficiency was premeditated and no patients mistakenly received acetylcysteine. The percentage of overall compliance with the protocol was 98.5%. The differences were statistically significant (p <0.01)
Attachment of relevant written information and/or photos, as appropriate
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Effectiveness of the Patient Safety Practice
 
Degree of implementation of reported practice
Yes, fully
Level of implementation of reported practice
Unit or ward level
Specific and measurable outcome for the reported practice were defined
Yes
A baseline measurement before implementation of the reported practice was obtained
Yes
A measurement after full implementation of the reported practice was obtained
Yes
Evaluation of a "positive" effect of the reported practice on Patient Safety
The evaluation showed improvements in Patient Safety outcomes
Type of before-and after evaluation
Quantitative
Enclosure of a reference or attachment in case of published evaluation's results
There is no specified text here
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Health care context where the Patient Safety Practices was implemented
 
Hospital
Transferability
 
Successful implementation of this Patient Safety Practice in other health care settings than above stated
Not known
Specification of implementation in another health care setting(s)
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Successful implementation's level  of this Patient Safety Practice across settings
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Involved health care staff
 
Physicians
Nurses
Pharmacists
Quality manager
Risk manager
Patient Involvement
 
Direct service user's involvement as integral part of this Patient Safety Practice
No
Specification of the service users or their representatives' involvement in the implementation of this Patient Safety Practice
There is no specified text here
Point of time in which service user or their reprasentatives' involvement takes place
There is no specified text here
Active seeking of service users' opinion, feedback, experience, etc. as integral part of this Patient Safety Practice
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Short description of the service users' level of involvement
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Public accessibility of information regarding this Patient Safety Practice to patients and citizens/service users
No
List of sources where public information is accessible
There is no specified text here
Implementation of the Patient Safety Practice
 
Existing collaboration with other countries or international organisations related to implementation of this Patient Safety Practice
No
Problems encountering in the implememntation course of this Patient Safety Practice like lack of motivation, no management support, etc.
No
List of the most prevelent difficulties encuntered during implementation of this Patient Safety Practice
There is no specified text here
List of the most prevalent drivers for a successful implemetation of this Patient Safety Practice
Motivated staff
Use of any specific incentives to enhance motivation while implementing this Patient Safety Practice
No
Description of used incentives, if any.
There is no specified text here
Existence of support or approval by the clinical or hospital management or any other hihg level authority in the implementation process of this Patient Safety Practice
Yes
Costs of the Patient Safety Practices
 
Completion of cost calculation related to this Patient Safety Practice
No
Total number of person days required to implement this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total number of person days required for training as preparation for implementation of this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total cost in Euro of specific equipment (machines, software, communications supplies, etc.) needed to support implementation of this Patient Safety Practice
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Associated cost with a work reduction or foregoing in order to deliver this Patient Safety Practice
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Contact information
 
Name: Julian Alcaraz Martinez
Country: SPAIN
Organisation: Hospital Morales Meseguer. Murcia
E-mail: julian.alcaraz2@carm.es
Phone: 0034636047506
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