NN&I - May 2010
Facility Management 46 Nephrology News & Issues May 2010www.nephronline.com that extra salary costs for pharmacists can be offset by savings in hospital admissions or costs of adverse drug reactions. It has been estimated that for every dollar that is spent on clinical pharmacy services for patients receiv-ing dialysis, the health care system saves approximately $4.00.26 Additional arguments in support of funding clini -cal pharmacy services for patients with CKD include excellence in patient care, patient safety, and meeting the recom-mendations of accrediting bodies.4,5,8ConclusionThe unique funding structure at the MRP for a clinical pharmacist has allowed our team to show value at the individual patient level and at the pop -ulation level with patient care, research, and educator responsibilities. References1. Coresh J, Selvin E, Stevens LA, et al. Prevalence of chronic kidney disease in the United States. JAMA. 2007;298:2038-47. 2. Manley HJ, Cannella CA, Bailie GR, et al. Medication-related problems in ambulatory hemo- dialysis patients: A pooled analysis. Am J Kidney Dis. 2005;46:669-80. 3. Gabardi S, Abramson S. Drug dosing in chronic kidney disease. Med Clin North Am. 2005;89:649-87. 4. Joint Commission. Managing Medications in Comprehensive Accreditation Manual for Hospitals: The Official Handbook (CAMH). Oakbrook Terrace, IL: The Joint Commission; 2009.5. CCHSA Accreditation Program 2008 Standards for Managing Medications available at www.cchsa-ccass.ca. Ottawa, ON: Accreditation Canada; 2007.6. Grabe DW, Low CL, Bailie GR, et al. Evalu-ation of drug-related problems in an outpatient hemodi- alysis unit and the impact of a clinical pharmacist. Clin Nephrol. 1997;47:117-21.7. Kaplan B, Mason NA, Shimp LA, et al. Chronic hemodialysis patients. Part I: Characterization and drug-related problems. Ann Pharmacother. 1994;28:316-9.8. Joy MS, DeHart RM, Gilmartin C, et al. Clinical pharmacists as multidisciplinary health care provid- ers in the management of CKD: A joint opinion by the nephrology and ambulatory care practice and research networks of the American College of Clinical Table 2. Clinical pharmacy services provided by Manitoba Renal Program pharmacists Direct patient careConduct comprehensive medication reviews (patient interviews \037 and chart reviews) Identify drug-therapy problems and design therapeutic plans to \037 prevent and resolve these problems. Review medication orders written prior to dispensing \037 Provide recommendations to prevent or solve drug-related problems \037 to the appropriate health care provider (including nephrologists, nurses, family physicians and community pharmacists) Provide pharmacokinetic consultations for patients receiving \037 medications with narrow therapeutic ranges Provide recommendations about drug dosing in reduced renal \037 function or for dialysis Ensure that patients receive appropriate medication coverage \037 Provide patient education/counseling \037 Monitor patients for desired outcomes and adverse effects \037 Review laboratory assessments between clinic visits and identify \037 and resolve any drug therapy problems Respond to drug information questions from the interdisciplinary \037 team and patients Attend and actively participate in interdisciplinary team rounds \037 Perform medication reconciliation on admission and discharge \037 from hospitalAdministrative/researchDevelop and review preprinted orders, intravenous monographs, \037 policies and procedures related to medications for provincial or institutional committees Prepare submissions for renal medications for provincial \037 or institutional formularies Coordinate and participate in a province-wide renal pharmacist \037 team meeting Develop standard operating procedures and standards of practice \037 for clinical pharmacy services Participate in provincial renal program committees (Standards, \037 Management Council, Professional Advisory Council) Conduct and participate in research \037EducationDirectly precept pharmacy students and pharmacy residents in the \037 clinical care of patients Coordinate and provide renal program pharmacist \037 continuing education Coordinate renal education (lectures and structured practical experi- \037 ential placements) for pharmacy students as well as post graduate pharmacy residents Provide continuing education for renal pharmacists, nurses and \037 physicians (nephrologists and primary care practitioners) Pharmaco Facility_6.indd 46 4/19/10 3:27:14 PM
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