Nephrotoxic medication (NTMx) exposure is a common cause of acute kidney injury (AKI) in hospitalized children. The Nephrotoxic Injury Negated by Just-in time Action (NINJA) program decreased NTMx associated AKI (NTMx-AKI) by 62% at one center. To further test the program, we incorporated NINJA across nine centers with the goal of reducing NTMx exposure and, consequently, AKI rates across these centers. NINJA screens all non-critically ill hospitalized patients for high NTMx exposure (over three medications on the same day or an intravenous aminoglycoside over three consecutive days), and then recommends obtaining a daily serum creatinine level in exposed patients for the duration of, and two days after, exposure ending. Additionally, substitution of equally efficacious but less nephrotoxic medications for exposed patients starting the day of exposure was recommended when possible. The main outcome was AKI as defined by the Kidney Disease Improving Global Outcomes (KDIGO) serum creatinine criteria (increase of 50% or 0.3 mg/dl over baseline). The primary outcome measure was AKI episodes per 1000 patient-days. Improvement was defined by statistical process control methodology and confirmed by Autoregressive Integrated Moving Average (ARIMA) modeling. Eight consecutive bi-weekly measure rates in the same direction from the established baseline qualified as special cause change for special process control. We observed a significant and sustained 23.8% decrease in NTMx-AKI rates by statistical process control analysis and by ARIMA modeling; similar to those of the pilot single center. Thus, we have successfully applied the NINJA program to multiple pediatric institutions yielding decreased AKI rates.

中文翻译：

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一项预期中的多中心质量改善计划（NINJA）表明，住院儿童的肾毒性急性肾损伤减少了。

肾毒性药物（NTMx）暴露是住院儿童急性肾损伤（AKI）的常见原因。即时行动（NINJA）否定的肾毒性伤害使一个中心的NTMx相关AKI（NTMx-AKI）降低了62％。为了进一步测试该计划，我们将NINJA纳入了9个中心，目的是减少这些中心的NTMx暴露，从而降低AKI率。NINJA对所有非危重住院患者进行高NTMx暴露筛查（同一天使用三种药物，或连续三天使用静脉内氨基糖苷），然后建议在暴露的患者中获得每日血清肌酐水平，持续时间为两次几天后，曝光结束。此外，在可能的情况下，建议从接触之日起，对暴露的患者替换同样有效但肾毒性较小的药物。主要结局是根据肾脏疾病改善全球结局（KDIGO）血清肌酐标准定义的AKI（比基线增加50％或0.3 mg / dl）。主要结局指标是每1000个病人日的AKI发作数。通过统计过程控制方法定义了改进，并通过自回归综合移动平均值（ARIMA）建模进行了确认。从建立的基线开始，在同一方向上连续八个连续两周一次的测量速率被视为特殊过程控制的特殊原因更改。通过统计过程控制分析和ARIMA建模，我们观察到NTMx-AKI率持续下降了23.8％。类似于试点单一中心的情况。因此，我们已经成功地将NINJA计划应用到了多个降低AKI发生率的儿科机构。