(1429) Clinical Evaluation of Pharmacy Operational Changes for Continuous Kidney Replacement Therapy

Introduction: Continuous kidney replacement therapy (CKRT) is a preferred method of kidney replacement therapy (KRT) for hemodynamically unstable patients. Continuous venovenous hemofiltration (CVVH) is a subtype of CKRT that utilizes replacement fluids. University Hospitals Cleveland Medical Center modified pharmacy operations to provide CVVH fluids as floor stock in intensive care units (ICUs) aiming to decrease time to CVVH start. The purpose of this study was to evaluate the clinical impact of pharmacy operational changes for the CVVH replacement fluid dispensing process.

Methods: This was a single-center retrospective study that included patients that received CVVH while admitted to an ICU between August 1, 2022 – December 31, 2022 (pre-implementation group) and February 1, 2023 – September 30, 2023 (post- implementation group). Time to CVVH start, incidence of appropriate antimicrobial dosing, and time to dose adjustment were compared between groups using independent samples Student’s t-test.

Results: 160 patients were included the study cohort, with 80 patients each in the pre- and post-implementation groups. Baseline characteristics between groups was similar, with the study cohort being mostly male (60.0% vs. 61.3%), with a mean age of 59.3 and 58.3 years. The mean time from ordering to CVVH start decreased from 5.0 hours to 3.7 hours post floor stock implementation (p=0.037). In patients with vascular access in place at CVVH ordering, the mean time to start decreased from 5.4 hours to 2.8 hours (p=0.045). Nearly all patients were administered an antimicrobial during CVVH therapy (91.3% vs 86.3%; p=0.317). The rate of appropriate dosing for antimicrobials with renal dose adjustments decreased after floor stock implementation (52.1% vs 46.4%; p=0.647). Of the patients in which dosing was not appropriate at CVVH start, the mean time from CVVH start to dose adjustment decreased from 12.3 hours to 11.3 hours (p=0.721).

Conclusions: The modification to provide CVVH replacement fluids as floor stock in ICUs resulted in decreased time to CVVH start. There was a decrease in the incidence of appropriate antimicrobial dosing after this change, which may be secondary to decreased pharmacy awareness of CVVH start time.