title: Interdisciplinary Systems-Based Intervention to Improve IV Hydration during Parenteral Administration of Acyclovir.
abstract: BACKGROUND
  Intravenous (IV) hydration is considered a protective factor in reducing the incidence of acyclovir-induced nephrotoxicity. A systems-based review of cases of acyclovir-associated acute kidney injury can be used to examine institution-, care provider-, and task-related factors involved in administering the drug and can serve as a basis for developing a quality improvement intervention to achieve safer administration of acyclovir.
  
  
  OBJECTIVE
  To explore the effectiveness of the study institution's inter-disciplinary quality improvement intervention in increasing the dilution of acyclovir before IV administration.
  
  
  METHODS
  After conducting a systems-based review for intervention development, a retrospective analysis was undertaken to compare IV administration of acyclovir in the 6-month periods before and after implementation of the intervention. The study population was a sequential sample of all patients over 18 years of age who were seen in the emergency department or admitted to a ward and who received at least one IV dose of acyclovir at the study institution. The primary outcome was the volume in which each acyclovir dose was delivered. The secondary outcomes were the hourly rate of fluid administration, the frequency of an increase in hourly hydration rate, and the incidence of acute kidney injury.
  
  
  RESULTS
  Eighty-four patients (44 in the pre-intervention period and 40 in the post-intervention period) received IV acyclovir and had evaluable data for the primary outcome. The median volume in which the acyclovir dose was administered was significantly higher in the post-intervention group (250 mL versus 100 mL, p < 0.001).
  
  
  CONCLUSIONS
  In this study, an easily implemented intervention significantly increased the volume of IV fluid administered to patients receiving acyclovir. Adequately powered prospective studies are suggested to investigate the effectiveness of this intervention on the clinically relevant incidence of acyclovir-induced nephrotoxicity.
authors.affiliation: MDCM, is an Internal Medicine Resident with the Department of Medicine, McGill University, Montréal, Quebec.
authors.forename: Lisa
authors.initials: L
authors.lastname: Dubrofsky
authors.affiliation: BPharm, MSc, is an Antimicrobial Stewardship Pharmacist with the Department of Pharmacy, Sir Mortimer B Davis Jewish General Hospital, Montréal, Quebec.
authors.forename: Ryan S
authors.initials: RS
authors.lastname: Kerzner
authors.affiliation: is a pharmacy student with the Faculté des sciences pharmaceutiques et biologiques, Université de Nantes, Nantes, France. At the time of the study, she was on an elective rotation with the Department of Pharmacy, Sir Mortimer B Davis Jewish General Hospital, Montréal, Quebec.
authors.forename: Chloë
authors.initials: C
authors.lastname: Delaunay
authors.affiliation: is a pharmacy student at Université Claude Bernard Lyon 1, Lyon, France. At the time of the study, she was on an elective rotation with the Department of Pharmacy, Sir Mortimer B Davis Jewish General Hospital, Montréal, Quebec.
authors.forename: Camille
authors.initials: C
authors.lastname: Kolenda
authors.affiliation: MSc, is Assistant Director of the Department of Pharmacy, Sir Mortimer B Davis Jewish General Hospital, Montréal, Quebec.
authors.forename: Jocelyne
authors.initials: J
authors.lastname: Pepin
authors.affiliation: MDCM, MHS, FRCPC, is an Attending Physician, Division of Internal Medicine and Department of Adult Critical Care, Sir Mortimer B Davis Jewish General Hospital, and an Assistant Professor, Department of Medicine, McGill University, Montréal, Quebec.
authors.forename: Blair C
authors.initials: BC
authors.lastname: Schwartz
keywords: acute kidney insufficiency; acyclovir; medication errors; patient safety