Evaluation on the clinical significance and level of acceptance of pharmacists’ recommendations in an adult renal ward in Hong Kong

Abstract Description

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Authors (including presenting author) :

Simon T. K. Kwok(1), Vivien Ng(1), Harry C. C. Chiu (1)

Affiliation :

(1)Pharmacy Department, Princess Margaret Hospital, Hong Kong

Introduction :

Clinical pharmacy service has been launched in the adult renal unit at Princess Margaret Hospital, Hong Kong since June 2017. Pharmacist participated in weekly renal ward rounds, delivered pre-dialysis talks to end stage renal failure patients, conducted discharge medication counseling services to patients with recent kidney transplantation, and assisted in departmental protocol updates.

Objectives :

This study aimed to identify the prevalence and pattern of drug related problems (DRPs) and to identify the acceptance level and evaluate the clinical significance of pharmacist-initiated clinical interventions (PIs) in an adult renal ward of an acute hospital in Hong Kong.

Methodology :

The study was a retrospective, single centered study carried out in a major 1600-bed acute hospital in Hong Kong. Pharmacist participated in weekly ward rounds with nephrologists and renal nurses in a 24-bed adult renal ward. Pharmacist would identify and provide suggestions on DRPs in patient with chronic kidney disease (CKD) or kidney transplantation. Pharmacists’ recommendations made during ward rounds from June 2017 to July 2018 were retrieved for analysis. The DRPs were classified according to predefined conditions and natures of DRPs. The clinical significance of the recommendations was assessed and ranked by two independent hospital clinical pharmacists not involved in making the recommendations using Hatoum’s scale.

Result & Outcome :

Pharmacist participated in 43 weekly ward rounds with 1,004 admissions reviewed. 153 suggestions and 33 pieces of drug information were provided by pharmacist during the ward rounds. Prevalence of DRPs: Most DRPs were active infection related (26.0 percent), peritoneal dialysis care (12.4 percent), cardiovascular care (9.6 percent), and anemia related (9.0 percent). Majority of the PIs were rectifying inappropriate drug/dose/frequency/duration/route (43.3 percent), discrepancy in regimen acknowledged during medication reconciliation (MR) (15.9 percent), and unattained therapy goal (9.8 percent). The top three drug classes involved were antibiotics, antivirals, and erythropoietin stimulating agents (ESA). Acceptance and Clinical Significance: The overall acceptance rate was 85.0 percent [level A (fully accepted): 74.5 percent; level B (accepted with alternation): 10.5 percent]. Among 153 pharmacist’s interventions, 92.2 percent were ranked with significant scores of 3 or above. 3.9 percent were classified into very significant recommendations with score 5 (suggestions qualified for a potential or existing major organ dysfunction if not identified). 51.0 percent were judged to be significant with score 4 (recommendations would bring care to a more acceptable and appropriate level). 37.3 percent were ranked to be somewhat significant with score 3, among them, MR and unattained hemoglobin goals on ESA were commonly described. Conclusion: Most DRPs reported were related to patient’s active problems during hospital stay, with the majority being infection related. More than half of PIs were ranked as significant or very significant. Pharmacist’s suggestions were appreciated with high implementation rate by nephrology team. The results of this review demonstrated that clinical pharmacist, as part of multidisciplinary team, can play a contributing role in enhancing medication safety and improving patient care in patient with CKD or kidney transplantation.