WVU nurse anesthetist grad monitoring acute kidney injury patients’ medications

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In leading a team of researchers, Chris Justice gained increased knowledge in caring for patients with acute kidney injury. (Submitted Photo)

Chris Justice was just barely 20 years old when he went to work as a registered nurse at WVU Medicine J.W. Ruby Memorial Hospital. Already, he knew he wanted to step up his education and career.

Living and working in Morgantown made it convenient for the native of Man to continue his education at West Virginia University. Choosing which path in health care to pursue was the dilemma, he said. That was until his work in the cardiovascular intensive care unit gave him the answer: anesthesia.

"I found that I enjoyed the critical thinking involved with caring for very sick patients," Justice said. "I mostly cared for patients recovering from cardiac surgery and patients on extracorporeal membrane oxygenation - ECMO - support. I also served as our unit's nursing champion for ECMO and was a charge nurse when I was still working full time. Pursuing anesthesia allowed me to keep taking care of critically ill patients and remain hands on, while expanding my scope of practice."

Now as a graduate of the second cohort of the WVU School of NursingDoctor of Nursing Practice Nurse Anesthetist program, Justice has more than academic and clinical experience. In leading a team of researchers, he gained increased knowledge in caring for patients with acute kidney injury.

Chris Justice, alumnus, Doctor of Nursing Practice Nurse Anesthetist program, WVU School of Nursing (Submitted Photo)

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Statistically, one in three patients recovering from cardiac surgery experience acute kidney injury, a condition that develops rapidly and results in the kidneys' inability to filter waste products from the blood. Acute kidney injury is a severe complication that is difficult to treat, being recognized as an independent predictor of morbidity and mortality.

"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 said. "Maintaining their fluid and electrolyte balance and blood pressure, searching for potential causes of the acute kidney injury and eliminating substances that may be toxic to the kidneys are good initial steps, but each patient will need interventions that are individualized."

As part of his clinical work, Justice was familiar with Dr. Ankit Sakhuja's alert system for identifying acute kidney injury in ICU patients. By utilizing the Kidney Disease Improving Global Outcomes criteria for activation, it indicates the severity of the condition as stage 1, 2 or 3 and remains active for 48 hours in the patient's chart as a passive reminder to the provider.

Sakhuja, a former WVU School of Medicine faculty member, suggested that Justice expand on the system by adding a specific alert into the electronic health record that would notify physicians, pharmacists and advanced practice providers of co-existing acute kidney injury and nephrotoxic medications.

Justice explained that prompt discontinuation of nephrotoxic medications in the setting of acute kidney injury has the potential to reduce injury severity and improve the overall outcomes experienced by these patients.

For his study, Justice and his colleagues set a goal of discontinuing nephrotoxic medications by 50% in the first 30 hours of a cardiac surgery patient developing acute kidney injury.

"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," Justice said. "Overall, we saw more nephrotoxic medications be discontinued after implementation of the nephrotoxin alert; in addition to a downward trend in hospital length of stay, acute kidney injury severity and number of patients that required dialysis."

The project also included a best practice checklist that can be used outside of cardiac surgery units.

Both alert systems remain in place at Ruby Memorial.

Justice's work earned second place in the poster presentation category at the West Virginia Healthcare Safety, Quality and Experience Improvement Research Day. Also known as the QI Fair, the event highlights efforts of doctors, staff, residents, fellows, students and researchers to improve outcomes for patients and their families.

He and his team have submitted their manuscript to Applied Clinical Informatics, where it is currently under review for publication.

"My DNP project would not have been possible without the numerous people that helped implement the alerts and AKI checklist," Justice said. "Dr. Aaron Ostrowski and Heather Carter-Templeton were my faculty of record for the project. Dr. Ankit Sakhuja and Dr. Khaled Shawwa were mentors from the beginning to the end of the project, often meeting multiple times per month to discuss progress. Connor Nevin, who finished his MD at WVU in May 2024, worked on the AKI alert with Dr. Sakhuja in 2020, aided in data collection, and has co-authored the manuscript. Rebecca Neely translated what we wanted the alert to be into a functioning product in the electronic health record."

As a certified registered nurse anesthetist - CRNA, Justice plans to continue his career at WVU Medicine Summersville Regional Medical Center. When not at work, he enjoys spending time with his family and fishing for striped bass.

-WVU-

MEDIA CONTACT: Linda Skidmore
Health Research Writer
WVU Research Communications
[email protected]

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