Dialysis: Filtering out the pharmacist role.

Abstract

Background: Clinical pharmacy service in dialysis is a growth area for renal pharmacy and is noted as an emerging role in the SHPA Standards of Practice in Nephrology. Patients on dialysis are ageing and multi[1]morbid with complex medication regimens. Pharmacists are key collaborators in the renal multidisciplinary team, managing complex medication regimens, preventing adverse events, and enhancing education. Objective: A scoping review was conducted to understand clinical pharmacy services offered to dialysis patients and outcomes measured. These results were combined with implementation methodology to develop and evaluate a service dialysing 60 onsite patients weekly. Action: A pharmacist service was implemented at 0.6 EFT, extending the previous supply-only model. The scoping review identified opportunities for action, and a priority list was discussed with the team. Evaluation: A combination of service metrics, staff and patient feedback, and system optimisation was used to build a clinical pharmacy service that meets the unit’s needs. Efficiencies for medicine supply, warfarin management, and medication history documentation were established, and a dashboard was developed (in the absence of an electronic medical record) displaying the virtual stock inventory of enoxaparin and iron, as well as clinical and medication chart review status. Discussion: Current medication therapies are documented and updated 2-monthly, with 542 histories documented for 104 patients at an average interval of 42 days over the past 22 months (September 2021-June 2024). Management of warfarin for 15 patients has been streamlined through the pharmacy service. The dialysis pharmacist has also been involved in erythropoiesis-stimulating agent tender strategy and compliance monitoring, and pharmacist involvement in the team has allowed for multidisciplinary meetings to be funded via National Weighted Activity Unit. Staff report the service as “invaluable to patients and staff” and “a welcome addition to improving outcomes for patients”. Future opportunities are in pharmacist-led anaemia and mineral-bone disease management.