• Erin K Stenson, Gina DeMasellis, Ananya Shah, Pamela D Reiter, John Brinton, Sara Martin, Melissa Iwanowski, Michael Rannie, Danielle E Soranno, and Katja M Gist.
• Section of Pediatric Critical Care, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO.
• Pediatr Crit Care Me. 2022 Dec 1; 23 (12): e564e573e564-e573.

ObjectivesQuality improvement initiatives to decrease rates of nephrotoxic medication exposure have reduced rates of acute kidney injury (AKI) in noncritically ill children. The objective of our study was to analyze the implementation of a similar program in critically ill children and to measure important balancing measures including opioid and benzodiazepine exposure.DesignProspective quality improvement study.SettingPICU at Children's Hospital Colorado between 2018 and 2020.PatientsAll children admitted to PICU.InterventionsQuality improvement initiative called Nephrotoxic Injury Negated by Just-In-Time Action (NINJA).Measurement And Main ResultsEight thousand eight hundred thirty-three PICU patient admissions were included. Mean rates of nephrotoxic medication exposure/1,000 PICU patient days decreased from 46 to 26, whereas rates of nephrotoxic AKI/1,000 PICU patient days did not change. Nonsteroidal anti-inflammatory drug dispenses per 1,000 patient days were reduced from 521 to 456. Similarly, opioid and benzodiazepine exposures per 1,000 patient days were reduced from 812 to 524 and 441 to 227, respectively, during the study observation period.ConclusionsThe NINJA intervention was efficaciously implemented in our single-center PICU. Nephrotoxic exposure is a modifiable factor that did not inadvertently increase exposure to opioids and benzodiazepines.Copyright © 2022 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

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