Quality Improvement Bedside Rounding Audits Enhance Protein Provision for Pediatric Patients Receiving Continuous Renal Replacement Therapy

Pediatr Crit Care Med. 2018 Nov;19(11):1054-1058. doi: 10.1097/PCC.0000000000001698.


Objectives: Describe quality improvement process improvements in protein delivery of continuous renal replacement therapy initiation.

Design: Prospective study.

Setting: PICU and cardiovascular ICU within a quaternary care children's hospital.

Patients: PICU and cardiovascular ICU patients receiving continuous renal replacement therapy for greater than 48 hours. Inborn errors of metabolism were excluded.

Interventions: Plan-Do-Study-Act cycles were initiated. Cycle 1 developed interdisciplinary quality improvement group continuously monitoring nutrition care with thrice weekly bedside safety rounds and protein prescriptions within nephrologist's notes. Cycle 2 included education to intensivists. Cycle 3 initiated monthly quality improvement meetings reviewing nutritional care goals.

Measurements and main results: Primary outcome was percentage of time patients met protein goals in the first 5 days of continuous renal replacement therapy. Secondary outcome was percentage of time patients met protein goals for duration of continuous renal replacement therapy. Cohort (n = 55) mean age was 8.1 years (SD ± 6.8), 62% male, and 31% malnutrition at baseline. Percent of time meeting protein goals by day 5 was 22%, 33%, and 71% and percent of time meeting protein goals throughout was 35%, 39%, and 75% of groups 1, 2, and 3, respectively. Significant improvement occurred after Plan-Do-Study-Act 3 (group 2 vs group 3; p < 0.01) for primary and secondary outcomes.

Conclusions: Implementation of an interprofessional quality improvement team significantly decreased number of continuous renal replacement therapy days with unmet protein goals and improved protein delivery.

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Dietary Proteins / administration & dosage*
  • Female
  • Humans
  • Intensive Care Units, Pediatric
  • Male
  • Nutritional Support / methods*
  • Outcome Assessment, Health Care
  • Patient Care Team / organization & administration
  • Prospective Studies
  • Quality Improvement
  • Renal Replacement Therapy / adverse effects*
  • Teaching Rounds


  • Dietary Proteins