Table 3.

Summary of NINJA Studies

Citation	Population	Intervention	Comparator	Outcome	Adaptations to NINJA
Goldstein 201335	Non-critically ill pediatric patients	Pharmacists manually screened Monday to Friday to assess for patients with high NTM (initial screening was manual until an automated EHR-generated screening report was developed) Daily SCr with substitution or therapeutic drug monitoring when possible	Evaluated project for 1 yr Phase 1 (6 mo manual screening), phase 2 (6 mo automated)	N = 21,807 patients included with n = 729 NTM patients (945 total events) AKI prevalence rate 25% Rate of patient with high NTM exposure 31% AKI intensity rate decreased by 42% with intervention When automated screening implemented, captured more compared with manual screening (11.6 vs 7.6 rate of exposure per 1000 patient-days)	Original definition (aminoglycosides ≥ 3 days or ≥ 3 NTMs within 24 hr) pRIFLE criteria used
Goldstein 201636	Non-critically ill pediatric patients	Additional 3-yr follow-up to assess if improvement was sustained	Compared with a priori standard of 8 consecutive weekly metric rates below the baseline rate (investigators assumed that initial baseline exposure rates would have persisted without project implementation)	N = 1749 patients with 3243 episodes of NTM exposure and N = 575 AKI occurrences Exposure rate decreased by 38% and the AKI rate decreased by 64% N = 633 exposures and 398 AKI episodes were avoided	KDIGO criteria used
Goldstein 202037	Non-critically ill pediatric patients at 9 centers	Automated screening report to identify patients’ NTM exposure Daily SCr during high NTM exposure and for 2 days post exposure or post-AKI resolution, whichever occurred last		N = 638,695 patients with 4513 episodes of NTM exposure and N= 746 AKI occurrences Observed a significant and sustained 23.8% decrease in AKI in patients with high NTM exposure	KDIGO criteria used
Stoops 201911	Level IV NICU (neonates and infants)	Automated screening report to identify patients with ≥3 NTMs within 24 hr or ≥4 calendar days of an IV aminoglycoside Daily SCr during high NTM exposure and for 2 days post exposure or post-AKI resolution, whichever occurred last	Pre-implementation (6 mo) vs sustainability (18 mo) with 1-mo washout period	N = 476 individual NTM exposure events with incidence of AKI 19.7% (n = 94/476) Systematic identification and daily SCr screening in high risk patients prevented 100 AKI episodes in 18-mo period Reduction in NTM exposures from 16.4 to 9.6 per 1000 patient-days(p = 0.03), reduction in percentage of NTM-AKI from 30.9% to 11% (p < .001), and reduction in AKI intensity from 9.1 to 2.9 per 100 susceptible patient-days (p < .001) while maintaining a high SCr surveillance rate.	Extension of IV aminoglycoside from 3 days to 4 or more days Definition of baseline SCr (first 14 days of life follow trends, after 14 days of life compare with lowest previous value) Semi-automated reporting system KDIGO criteria used
Newton 202132	Cystic fibrosis patients (0 to 21 yr)	Automated screening report to identify patients with ≥3 NTMs within 24 hr or ≥4 calendar days of an IV aminoglycoside or vancomycin SCr screening 3 days a week in patients at high risk	Pre-implementation (4 mo) vs sustainability (4 mo) with no washout period	N = 19 patients with 25 NTM exposure events Increased SCr monitoring uncovered more episodes of AKI in the post-implementation phase	Used the pRIFLE criteria SCr screening 3 times weekly (Monday, Wednesday, Friday)

AKI, acute kidney injury; EHR, electronic health record; IV, intravenous; KDIGO, Kidney Disease: Improving Global Outcomes; N, number of patients; NICU, neonatal intensive care unit; NINJA, Nephrotoxic Injury Negated by Just-in-Time Action; NTM, nephrotoxic medication; pRIFLE, Pediatric Risk, Injury, Failure, Loss, and End-Stage Renal Disease; SCr, serum creatinine