In 2019, Mercy Health St. Mary’s Grand Rapids had a Contrast-Induced Nephropathy (CIN) rate of 9.4%. A move from Cerner to Epic allowed the team to have a streamlined order set that all of the physicians are expected to use. They also created custom phrases for hydration orders to streamline quality patient care. This included having a specific CIN policy for heart and vascular. The team created a type of grid to use for dosing hydration that is based on patient GFR lab results. (If patient GFR is X, then please hydrate at Y.) Then, the standard 50 mLs per hour per sedation policy is used with titration up and down based on the patient’s GFR.
Additionally, the team added a dye max load into their timeout so that everyone in the room would know how much contrast the patient should get, with the monitor providing verbal updates throughout the procedure. As a result of these changes, the 2020 CIN rate was 1.75%.