1309 / Kidney prophilaxis prior to computed tomography (CT)

SPAIN
Classification of the PSP
Type of Patient Safety Practice Not Evaluated
 
Clinical Practice (CP)
Related practices from PaSQ database
"Best fit" category of the reported practice
Diagnostics
There is no specified text here There is no specified text here
Topic of the reported practice
Clinical risk management
Aim and the benefit of the Patient Safety Practice
 
Contrast induced acute kidney injury (AKI) is a very important complication in the use of iodinated contrast media and accounts for a significant number of cases of hospital acquired AKI.
Chronic kidney disease (CKD) is an independent risk predictor for developing AKI after iodinated contrast administration, therefore we propose a strategy to reduce the risk of AKI in outpacients with CKD who are going to perform a computed tomography (CT) with iodinated contrast .
Description of the Patient Safety Practice
 
The iodinated contrast-induced nephropathy (CIN), defined as an increase of serum creatinine >0.5mg/dl (44 µml/l) or an increase of 25% regarding basal levels determined 48 hours after de procedure, is a frequent cause of acute kidney injury (AKI). Several procedures to minimize risks have been pointed out.
We proceed to show our experience with outpatients who were undergoing contrast-enhanced CTs for over 4 years (from January 2011 to April 2015)
METHODS
We selected 217 patients with a CKD-EPI estimated glomerular filtration rate <40ml/min. The prophylaxis took place in the nephrology day hospital. The patients were asked to take N- acetylcysteine 600mg orally twice daily for three days, starting the day before the CT. The day on which the patients underwent the contrast- enhanced CT, they were hydrated with intravenous 1/6 M sodium bicarbonate to doses of 1ml/kg/ h for three hours before the CT was carried out and after that the serum was administered in doses of 3ml/kg/ hour for three more hours. Subsequently, they went home and were asked to come back 48 later to determine their creatinine levels.
IMPLEMENTATION
Evaluating the literature and after coming to an understanding with the urogenital radiologists I decided to propose a strategy to prevent contrast –induced acute kidney injury.
I spread the protocol to other professionals in the hospital in a general session .
Currently the implementation of this protocol is a quality and security indicator of the Nephrology Service.
RESULTS
A) EPI between 30 and 40 ml/min (78 patients)

Creatinine pre (mg/dl) EPI pre (ml/min) Creatinine post ( mg/dl) EPI post (ml/min)
159,78 33,75 162,24 32,42

- 5 patients: their kidney function worsened.
3 patients complied with contrast nephropathy criterion
ADMISSION + serumtheraphy.
1 patient: urinary Sepsis.
1 patient: obstructive nephropathy
B) EPI between 20 and 30 ml/ min (109 patients )
Creatinin pre ( mg/dl) EPI pre (ml/min) Creatinine post ( mg/dl ) EPI post (ml/min)
197,02 26,25 194,08 27,24
- 3 patients: Their kidney function worsened.
2 patients complied with contrast nephropathy criterion
ADMISSION + serumtheraphy.
1 patient: obstructive nephropathy

C) EPI between 10 and 20 ml/min (30 patients)
Creatinine pre ( mg/dl) EPI pre (ml/min) Creatinine post ( mg/dl) EPI post (ml/min)
340 14,77 345,14 13,92


2 patients: Their kidney function worsened.
Both patients complied with the contrast nephropathy criterion.

Among the 217 patients who took part in the test, only one didn't come to the renal function control 48 hours after the test and it was impossible for us to come into contact with him. Other 8 patients were controlled in another centre.
Attachment of relevant written information and/or photos, as appropriate
There is no specified text here
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Effectiveness of the Patient Safety Practice
 
Degree of implementation of reported practice
Yes, fully
Level of implementation of reported practice
Institution level
Specific and measurable outcome for the reported practice were defined
Yes
A baseline measurement before implementation of the reported practice was obtained
No
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
There is no specified text here
Health care context where the Patient Safety Practices was implemented
 
Home care
Other or not relevant
Transferability
 
Successful implementation of this Patient Safety Practice in other health care settings than above stated
Yes
Specification of implementation in another health care setting(s)
Hospital
Successful implementation's level  of this Patient Safety Practice across settings
Yes, across multiple specialities within the same setting
Involved health care staff
 
Physicians
Nurses
Patient Involvement
 
Direct service user's involvement as integral part of this Patient Safety Practice
Yes
Specification of the service users or their representatives' involvement in the implementation of this Patient Safety Practice
Patient(s)
Relative(s)
Point of time in which service user or their reprasentatives' involvement takes place
During the application of the Patient Safety Practice
Active seeking of service users' opinion, feedback, experience, etc. as integral part of this Patient Safety Practice
No
Short description of the service users' level of involvement
User-led, where the service users control the development and implementation of the PSP
Public accessibility of information regarding this Patient Safety Practice to patients and citizens/service users
Yes
List of sources where public information is accessible
You can find the information in the Intranet hospital and it was it was accepted as oral communication in the Spanish national nephrology congress 2015 and it also was accepted as Poster in the catalan XVII Journey to Quality patient Care .
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
Not relevant
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
There is no specified text here
Associated cost with a work reduction or foregoing in order to deliver this Patient Safety Practice
There is no specified text here
Contact information
 
Name: PILAR BAXARIAS
Country: SPAIN
Organisation: FUNDACIÓ PUIGVERT
E-mail: pbaxarias@fundacio-puigvert.es
Phone: There is no specified text here
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