An Evaluation of Pharmacist Recommendations on Patient Outcomes in a CAPD Clinic

An evaluation of pharmacist recommendations on
patient outcomes in a CAPD clinic 135
A. Brady, T. Garrett, A. Osborne
King’s College Hospital, London, United Kingdom.
Background: Many UK renal units have specialist pharmacist input,
however pharmacist input in clinics has not been widely assessed.
Patients on continuous ambulatory peritoneal dialysis (CAPD) have complex
drug regimens and a high incidence of drug related problems (DRPs).
Pharmacist intervention in DRPs may improve patient outcome.
Aim: To evaluate DRPs in a CAPD clinic and the clinical outcomes of a
specialist pharmacists’ recommendations.
Method: CAPD patients were seen in a multidisciplinary review clinic
comprising consultant nephrologist, registrar, renal pharmacist, renal
dietitian and CAPD nurses. Clinic records for 41 patients, pharmacists’
recommendations and consultant and registrar acceptance were reviewed.
Clinical data (e.g. BP, Hb, Ca/P04) were collected to assess outcomes.
Results: A total 41 patients were seen in 51 clinic appointments, median age
55, 44% male. Patients received a median of 9 drugs (range 5-19). Of drug
histories documented, 89% were inaccurate. Pharmacists made 2.12
recommendations per patient, 85 % were accepted. The most common
recommendations were initiation or increase in therapy (44%), update
inaccurate drug history (22%) and stop or reduce therapy (13%). Outcomes
were available for 41 patients, 40/60 (67%) clinical parameters improved
after pharmacists recommendations.
Conclusion: CAPD patients have multiple drugs and many DRPs, requiring
continual review of therapy. A high proportion of pharmacist
recommendations were accepted. Specialist pharmacist’s input improves
patient outcomes by ensuring optimal therapy and accurate medication
documentation.