Abstract: TH-PO316
Towards a Greener Practice: Implementation of Continuous Kidney Replacement Therapy Waste Reduction
Session Information
- Hemodialysis and Frequent Dialysis - 1
October 24, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Moore, Megan M., Texas Children's Hospital, Houston, Texas, United States
- Mottes, Theresa Ann, Ann and Robert H Lurie Children's Hospital of Chicago Foundation, Chicago, Illinois, United States
- Daniel, Jennifer L Morris, Imagine Pediatrics LLC, Nashville, Tennessee, United States
- Sarasak, Gracious, Texas Children's Hospital, Houston, Texas, United States
- Thadani, Sameer, Baylor College of Medicine, Houston, Texas, United States
- Dolan, Kristin J., Baylor College of Medicine, Houston, Texas, United States
- Braun, Michael C., Baylor College of Medicine, Houston, Texas, United States
- Akcan Arikan, Ayse, Baylor College of Medicine, Houston, Texas, United States
Background
Dialytic therapies are significant contributors to the medical carbon footprint. With the increasing prevalence of continuous renal replacement therapy (CRRT) in pediatric patients, there is a need to implement systematic waste-reduction strategies to mitigate the environmental impact and increase long-term sustainability. We noted 12% of CRRT fluid bags dispensed monthly were wasted for a multitude of reasons within our health system. We utilized implementation science methodology to unpack the complex workflow and identify barriers and facilitators of pharmacy and other system processes to reduce medical waste for our CRRT program.
Methods
We leveraged Expert Recommendations for Implementing Change (ERIC) to assess drivers of CRRT waste and manage change. A multidisciplinary expert panel was assembled to map change objectives and manage change. We identified process problems (incorrectly timed daily dispensing [before daily rounds]), prescriber and pharmacist knowledge gaps, communication barriers between unit pharmacists and prescribers as barriers. Between 2019 and 2022, numerous interventions were implemented to decrease dialysate and replacement fluid bag waste including increasing awareness to the problem through education, process standardization, electronic medical record (EMR) embedded decision aids, and standardization of replacement fluids.
Results
Following the first phase of multidisciplinary team education, monthly fluid waste decreased from 12% to 9.3% over 13-months from July 2019 to July 2020. With EMR optimization and process enhancement in August 2020, monthly waste decreased by another 1.8% to 7.5% by February 2022. With standardization of replacement fluids, our monthly waste decreased by an additional 3.7% to 3.8% by December 2023. Overall, our interventions reduced monthly waste by 8.2% for an annual cost savings of $34,079 (28%).
Conclusion
Identification of systematic processes resulting in waste with structured change management through multidisciplinary team engagement can lead to reductions in overall dialytic therapies related waste. Future studies should continue to evaluate methods to decrease the impact of dialytic therapies on our environment.