Hemodialysis Dialysis Pharmacist

Assess new patients on Hemodialysis Dialysis within 1 week of initiating

• training
• chart review
• interview patient to clarify medication history, compliance, Hepatitis B status and other DRP's
• educate patient as needed
• provide pt with a list of their current medications
• discuss follow-up plan with patient
• establish a pharmacy monitoring plan/system
• document assessment is progress notes of patient's chart
• document workload for stats

Review routine blood work (every 4-6 weeks depending on your unit)

• review routine lab work (ensure that drug levels (dig, dilantin, VPA etc) have been included for patients receiving such medications)
• F/U with patients who have deviations that could be related to drug therapy (ie. PO4, Ca, PTH, Hb, Ferr, Fe Sat, LFT's, lipid profile). Educate as needed.
• add any issues to your pharmacy monitoring plan and follow up with patient within 2 weeks
• document DRP's and interventions in the progress notes of patient's chart
• contact physician or allied health professionals regarding concerns or issues as necessary
• document workload stats

Anemia management

• monitor Hb, Hct, Ferr, % Fe Sat, B12, RBC folate, % retics to assess need for or response to Eprex &/or iron therapy
• recommend supplementation of B12 & folic acid if levels below normal for patients age
• target Hb 110-125 as per CSN & DOQI guidelines
• target ferritin levels >100 as per CSN & DOQI guidelines
• % Fe sat of at least 0.2 (20%) as per CSN & DOQI guidelines
• assess patient compliance with prescribed anemia therapy. Intervene & educate patient as necessary
• recommend IV iron therapy for anyone with a ferritin level <100
• recommend changes in Eprex therapy as deemed appropriate
• document DRP's and recommendations in progress notes of patient's chart
• add any issues to your pharmacy monitoring plan and follow up as appropriate
• ensure patient has a MOH Eprex funding form completed for reimbursement
• contact physician to discuss plans/recommendations as necessary
• document workload for stats

Follow up with each patient once every 4 months

• review medication list in chart/kardex with what patient is taking
• make recommendations & provide education as necessary
• provide patient with updated medication list
• contact physician or allied health professionals to discuss concerns or plans for patient as necessary
• document DRP's or other issues in the progress notes of patient's chart
• document workload for stats

Follow up with patients identified by other members of the Health Care Team as necessary

• deal with the identified issue
• document in the progress notes of the patient's chart
• if follow up is required add to patient's pharmacy monitoring plan
• document workload for stats

Contribute to education of the Health Care Team

• answer drug information questions from team members
• do inservices on topics of interest to the other team members
• take part in the development of forms, protocols, policies and
• procedures related to medication used by the peritoneal dialysis program

Contribute to the education of patients & their families

• contribute articles to newsletters for patients
• create or provide printed information pamphlets as needed
• take part in educational events that the patient services committee(or your programs equivalent) is organizing
• volunteer to speak at patient focused educational sessions sponsored by the Kidney Foundation of Canada, the Diabetes Association, the Heart & Stroke Association etc.

Promote seamless care with other professionals involved in the patient's health care

• provide the inpatient pharmacist with a copy of your pharmacy monitoring
• plan and a list of the patient's current medications when (s)he is admitted to the hospital
• if patient ends up not tolerating or "failing" PD then forward your pharmacy
• monitoring plan and your initial patient assessment to the pharmacist working in hemodialysis
• if your patient is transplanted forward a copy of the patients current medications, your initial assessment and the pharmacy monitoring plan to the pharmacist working on the transplant floor
• if your patient moves to another part of Ontario or out of the province forward your assessment, pharmacy monitoring plan and current medication list to the renal pharmacist at the patient's new location
• send a letter to the patients community pharmacist indicating that this patient is now on dialysis therefore doses of new medications should be adjusted for a ClCr <10 mL/min. A copy of the updated medication record that you gave to the patient should also be included with the letter.

Foster an open line of communication between pharmacy & dialysis

• attend multidisciplinary rounds as frequently as your unit has them
• attend dialysis program council (or equivalent) meetings regularly
• attend dialysis unit staff meetings
• attend pharmacy meetings
• report workload stats to both dialysis & pharmacy program leaders on a monthly basis