A pharmacy-based medication reconciliation and review program in hemodialysis patients: a prospective study

Keywords: Medication Reconciliation, Medication Errors, Renal Dialysis, Interprofessional Relations, Pharmacists, United States

Abstract

Background: Hemodialysis (HD) patients are on multiple medications, see many prescribers and have many hospitalizations which put them at risk for medication record discrepancies and medication related problems (MRP). Being able to effectively identify and reconcile these medication issues is crucial in reducing hospitalizations, morbidities, and mortalities. The care of the hemodialysis patients can be enhanced by incorporating a pharmacist into the interprofessional team. There is little data in the literature on medication record discrepancies and MRP’s in dialysis patients.

Objective: The objectives of this research were to determine the types of medication discrepancies and MRPs in dialysis patients and if recommendations for changes based on these findings were accepted by providers.

Methods: Patients were asked to bring medications to the dialysis unit for review. Discrepancy and MRP recommendations were communicated to the unit staff via written progress notes. A follow-up was performed an average of 33 days later to determine if the recommendations were accepted.

Results: Overall, in 93 unique patients, 376 discrepancies (3.1 per patient) and 64 MRPs (0.5 per patient) were identified. The most common type of discrepancy and MRP was drug omission and indication without drug, respectively. Of the total 440 interventions, 77% were ultimately accepted. Discrepancies were more likely to be accepted as compared to MRPs (85% vs. 27%, respectively).

Conclusion: Medication record discrepancies and MRPs are common in dialysis patients. Recommendations related to discrepancies were more likely to be accepted by the providers as compared to MRPs. Medication records became inaccurate within 12 months. A pharmacy-based medication reconciliation and review program may have an important impact on the care of hemodialysis patients.

Downloads

Download data is not yet available.

Author Biography

Edward F. Foote
Pharm.D., FCCP, BCPS
Professor and Chair
Department of PharmacyPractice

References

1. Pai AB, Cardone KE, Manley HJ, St Peter WL, Shaffer R, Somers M, Mehrotra R; Dialysis Advisory Group of American Society of Nephrology. Medication reconciliation and therapy management in dialysis-dependent patients: need for a systematic approach.. Clin J Am Soc Nephrol. 2013;8(11):1988-1999. doi: 10.2215/CJN.01420213

2. Medication Reconciliation to Prevent Adverse Drug Events. http://www.ihi.org/topics/adesmedicationreconciliation/Pages/default.aspx (accessed September 25, 2015).

3. Jack BW, Chetty VK, Anthony D, Greenwald JL, Sanchez GM, Johnson AE, Forsythe SR, O'Donnell JK, Paasche-Orlow MK, Manasseh C, Martin S, Culpepper L. A reengineered hospital discharge program to decrease rehospitalization: a randomized trial. Ann Intern Med. 2009;150(3):178-187.

4. Schnipper JL, Kirwin JL, Cotugno MC, Wahlstrom SA, Brown BA, Tarvin E, Kachalia A, Horng M, Roy CL, McKean SC, Bates DW. Role of pharmacist counseling in preventing adverse drug events after hospitalization. Arch Intern Med. 2006;166(5):565-571.

5. Kwan JL, Lisha L, Margaret S, Shojania KG. Medication reconciliation during transitions of care as a patient safety strategy: a systematic review. Ann Intern Med. 2013;158(5 Pt 2):397-403. doi: 10.7326/0003-4819-158-5-201303051-00006

6. Saran R, Li Y, Robinson B, Ayanian J, Balkrishnan R, Bragg-Gresham J, Chen JT, Cope E, Gipson D, He K, Herman W, Heung M, Hirth RA, Jacobsen SS, Kalantar-Zadeh K, Kovesdy CP, Leichtman AB, Lu Y, Molnar MZ, Morgenstern H, Nallamothu B, O'Hare AM, Pisoni R, Plattner B, Port FK, Rao P, Rhee CM, Schaubel DE, Selewski DT, Shahinian V, Sim JJ, Song P, Streja E, Kurella Tamura M, Tentori F, Eggers PW, Agodoa LY, Abbott KC. US Renal Data System 2014 annual data report: epidemiology of kidney disease in the United States. Am J Kidney Dis. 2015;66(1 Suppl 1):Svii, S1-S305. doi: 10.1053/j.ajkd.2015.05.001

7. Smith S, Witten B, Paykin C, Weiner S, Chianchiano D, St Peter WL. Medicare Part D: challenges for dialysis patients (part 2 of 2): opportunities to improve patient experiences. Nephrol News Issues. 2011;25(13):24-29.

8. ASHP Statement on Pharmaceutical Care. http://www.ashp.org/DocLibrary/BestPractices/OrgStPharmCare.aspx (accessed September 7, 2015).

9. Ernst FR, Grizzle AJ. Drug-related morbidity and mortality: updating the cost-of-illness model. J Am Pharm Assoc (Wash). 2001;41(2):192-199.

10. Johnson JA, Bootman JL. Drug-related morbidity and mortality. A cost-of-illness model. Arch Intern Med. 1995;155(18):1949-1956.

11. Manley HJ, Barton-Pai A. Integrated pharmacy services: a necessary component for care of patients treated by long-term dialysis. Am J Kidney Dis. 2013;62(3):445-447. doi: 10.1053/j.ajkd.2013.06.004

12. Leung M, Jung J, Lau W, Kiaii M, Jung B. Best possible medication history for hemodialysis patients obtained by a pharmacy technician. Can J Hosp Pharm. 2009;62(5):386-391.

13. Manley HJ, Cannella CA, Bailie GR, St Peter WL. Medication-related problems in ambulatory hemodialysis patients: a pooled analysis. Am J Kidney Dis. 2005;46(4):669-680.

14. Ong SW, Fernandes OA, Cesta A, Bajcar JM. Drug-related problems on hospital admission: relationship to medication information transfer. Ann Pharmacother. 2006;40(3):408-413.

15. Pai AB, Boyd A, Depczynski J, Chavez IM, Khan N, Manley H. Reduced drug use and hospitalization rates in patients undergoing hemodialysis who received pharmaceutical care: a 2-year, randomized, controlled study. Pharmacotherapy. 2009;29(12):1433-1440. doi: 10.1592/phco.29.12.1433

16. Manley HJ, Drayer DK, Muther RS. Medication-related problem type and appearance rate in ambulatory hemodialysis patients. BMC Nephrol. 2003;4:10.

17. Tang I, Vrahnos D, Hatoum H, Lau A. Effectiveness of clinical pharmacist interventions in a hemodialysis unit. Clin Ther. 1993;15(2):459-464.

18. Kaplan B, Shimp LA, Mason NA, Ascione FJ. Chronic hemodialysis patients. Part II: Reducing drug-related problems through application of the focused drug therapy review program. Ann Pharmacother. 1994;28(3):320-324.

19. Possidente CJ, Bailie GR, Hood VL. Disruptions in drug therapy in long-term dialysis patients who require hospitalization. Am J Health Syst Pharm. 1999;56(19):1961-1964.
Published
2016-09-29
Section
Original Research