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RENAL PHARMACIST OPTIMISES HEALTH OUTCOMES FOR PATIENTS

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European Statement

Introductory Statements and Governance

Author(s)

A. Frisch, D. Scharlemann-Moenks, K. Heinitz, R. Frontini

Why was it done?

Limited resources require optimisation of pharmacists’ interventions (EAHP Statement 1.3). Due to the limited number of clinical pharmacists (5/1350 beds) only a few wards were served by the pharmacy. We aimed to improve the effectiveness by covering selected patients in all wards and compared the results with a classic visit.

What was done?

Instead of visiting all patients in selected wards, pharmacists focused on patients with critical renal insufficiency across all wards.

How was it done?

The central laboratory identified patients as high risk when their glomerular filtration rates were <30 ml/min, and alerted the pharmacy via email. For those patients, the renal pharmacist analysed the prescribed medication at least twice weekly throughout their hospital stay for medication errors, dosing and interactions, and suggested alternatives where necessary. Interventions were discussed either directly with the doctors or by written advice. The major obstacle was the fact that clinical services by pharmacists were unknown in most wards and that some of the doctors were sceptical about the pharmacist`s competency. We overcame these obstacles by intensive collaboration with the nephrology department.

What has been achieved?

Over 20 months involving 4229 visits, the renal pharmacist analysed the medication of 2125 patients who had 11 different drugs on average. The pharmacist assessed 47 584 medications, resulting in 2900 interventions, of which 1292 were renal and 1608 other. The most common interventions for renal patients were dosage adjustments (20%), contraindications (16%) and interactions (10%). Overall, the number of interventions (6.1% of medication items) and their severity across all renal insufficiency patients exceeded those on the visceral surgical ward (2.4%) over the same time as a comparator, confirming the higher effectiveness of the intervention.

What next?

To conduct further studies on medication safety, we established a centre for drug therapy safety in collaboration with the faculty of pharmacy with the aim of discovering valid criteria for identifying other high risk patients.

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