A Process for Pre-Scan Intravenous Fluid Hydration Orders to Prevent Contrast-Induced Nephropathy
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Date
2025-05
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The Ohio State University
Abstract
Using contrast medium (CM) in computed tomography (CT) scans has become increasingly common in therapeutic evaluation and diagnostic purposes for cancer patients. There is significant health risks associated with the use of CM especially for acute kidney injury (AKI). These risks depend upon the patients' comorbidities, and they can be mitigated through pre-scan hydration. At a designated NCI-NCCN outpatient skin oncology clinic, a process for ordering pre-scan hydration for cancer patients during the clinic focusing on patients age 70 years or older, was developed. The object was to provide education on prevention of contrast-induced nephropathy (CIN) with the goals of increasing the number of pre-scan intravenous fluid (IVF) hydration orders placed when ordering scans and identify barriers to placing these orders from providers. For this quality improvement project, the Plan-Do-Study-Act (PDSA) cycle was utilized as the methodology. The project included an educational intervention targeting clinicians, nurses, and schedulers. This intervention also included questions about the barriers to ordering the pre-scan IVF hydration. The expected outcome was to increase the hydration orders by 10% within two months. After two months of implementation, the results showed an increase in pre-scan IVF hydration orders from 17.6% (pre-implementation) to 24% after implementation. In summary, the project showed that developing a process for ordering pre-scan IVF hydration and education on CIN improved the rates of pre-scan IVF hydration orders in the outpatient skin oncology clinic.