EVALUATION OF DRUG-RELATED PROBLEMS IN AN OUTPATIENT HEMODIALYSIS UNIT AND THE IMPACT OF A CLINICAL PHARMACIST

Purpose: Drug-related morbidity and mortality are significant problems in the U.S. Recognition and resolution of drug-related problems (DRP) will decrease drug-related morbidity and mortality and promote optima l therapeutic outcomes. It was the objective of this study to identify DRP in hemodialysis outpatients by performing medication reviews; mak e appropriate recommendations and determine the significance of any in terventions; and estimate outcome in terms of any changes in number of medications/patient or doses/day. Methods: A thorough medication revi ew was conducted with each patient after review of the computerized me dication profiles and medical records. Each updated profile was assess ed by a clinical pharmacist for the presence of any of the 8 classical DRP plus 2 additional categories (therapeutic duplication and other [ specific for dialysis eg. dry weight]). Appropriate recommendations we re made to the physician. Accepted recommendations were deemed as inte rventions and assigned a significance rank on a published scale of 1 ( adverse significance) to 6 (extremely significant) by each of the inve stigators, A final rank was assigned upon agreement between investigat ors. Changes in numbers of doses/day or medications/patient were deter mined. Results: 49 patients were reviewed and 45 patients (21 women, 2 4 men) were included in the final analysis, Over one month 126 DRP wer e identified and 102 interventions were made. Drug interactions consti tuted the most common DRP (27.5%). The second most common DRP (26.5%) was in the dialysis-specific group. The number of interventions per si gnificance rank were as follows: rank 1: 0 (0%); rank 2: 7 (6.9%); ran k 3: 9 (8.8%); rank 4: 80 (78%); rank 5: 5 (4.9%); rank 6: 1 (1%). Pat ients were taking a mean of 10.9 +/- 3.9 medications and a mean of 14. 5 +/- 6 doses/day (range, 2-33) prior to the study and 10.7 +/- 4 and 14.4 +/- 5.8 by the end of the study period. Conclusions: With the add ition of a clinical pharmacist in an hemodialysis unit numerous DRP we re detected and interventions made. The majority of interventions were significant and possibly led to better therapeutic outcomes.