Chris Justice, a recent graduate of the Doctor of Nursing Practice Nurse Anesthetist program at West Virginia University, has developed an innovative alert system to monitor medications for patients experiencing acute kidney injury.
Justice’s journey began at just 20 years old when he started working as a registered nurse at WVU Medicine’s J.W. Ruby Memorial Hospital in Morgantown. His role in the cardiovascular intensive care unit inspired his pursuit of anesthesia. “I found that I enjoyed the critical thinking involved with caring for very sick patients,” Justice said. “Pursuing anesthesia allowed me to keep taking care of critically ill patients and remain hands on, while expanding my scope of practice.”
In his new role, Justice collaborated with a research team, focusing on the management of acute kidney injury, a serious complication that often arises after cardiac surgery. Statistics reveal that one in three patients recovering from such surgery develops this condition, which hampers the kidneys’ ability to filter waste effectively.
“Patients with acute kidney injury require very close monitoring and, often, a great deal of care to give them the best chance at recovery,” Justice explained. He emphasized the need for maintaining the fluid and electrolyte balance and searching for potential causes to provide individualized patient care.
Justice was inspired by an existing alert system designed by Dr. Ankit Sakhuja at the hospital. This system, which uses the Kidney Disease Improving Global Outcomes criteria, helps in identifying the severity of acute kidney injury. Sakhuja encouraged Justice to enhance the system by integrating alerts into electronic health records to notify medical professionals of nephrotoxic medications, which could worsen patients’ conditions.
“The nephrotoxin alert passively identifies nephrotoxic medications that the patient is already on and provides a hard stop when new orders for nephrotoxic medications are being placed,” said Justice. His team aimed to reduce the use of these medications by 50% within the first 30 hours of a patient developing acute kidney injury.
Following the implementation of the nephrotoxin alert, Justice observed a positive trend: more nephrotoxic medications were discontinued, alongside a reduction in both the severity of acute kidney injury and hospital stay lengths.
The initiative also included a best practice checklist that can be applied beyond cardiac surgery units. Both alert systems remain active at Ruby Memorial Hospital.
For his efforts, Justice received second place in the poster presentation category at the West Virginia Healthcare Safety, Quality and Experience Improvement Research Day, an event showcasing improvements in healthcare outcomes by various medical professionals.
Justice’s manuscript detailing this project has been submitted to Applied Clinical Informatics and is currently under peer review. He expressed gratitude towards his collaborators, stating, “My DNP project would not have been possible without the numerous people that helped implement the alerts and AKI checklist.”
Looking ahead, Justice plans to further his career at WVU Medicine Summersville Regional Medical Center as a certified registered nurse anesthetist. In his free time, he enjoys fishing for striped bass and spending valuable moments with family.
