Pharmacists playing more important role in dialysis treatment

Since retiring, Abrahams has put his skills as a pharmacist to work in the hospital's dialysis unit. He is a one-man band, responsible for reviewing lab reports and patients' medical histories and coming up with drug therapies for the nearly 200 patients undergoing dialysis.

Some states-such as New Jersey and Florida-require dialysis centers to have a pharmacist on staff. New Jersey requires pharmacists in these centers to review policies and procedures, offer educational programs, review medical records on a quarterly basis, and submit quarterly written reports.

Two years ago, the Centers for Medicare & Medicaid Services mulled a proposal to require pharmacists to play a more active role in reviewing medication regimens for dialysis patients. The proposal, supported by ASHP, said pharmacists "have the education and experience to provide critical services that can promote safer and more effective medication use."

"These are high-risk patients," said Teresa Rubio, Pharm.D., director, Section of Inpatient Care Practitioners for ASHP. "Pharmacist involvement with this population is really important. A pharmacist can detect and resolve medication issues as a member of the dialysis healthcare team."

Pharmacists also can counsel ESRD patients and act as a resource for nurses working in the unit. Perhaps more important, having a pharmacist involved in dialysis enables nurses to better care for ESRD patients.

Before he retired, Abrahams spent two hours a day addressing questions from nurses assigned to the dialysis unit and initiating new drug therapies for patients. He was given two eight-hour days each month to evaluate lab reports, monitor the unit's 190 patients, and write orders. Since retiring, he has turned that 16-hour stint each month into 80-an increase he claims allows him to better control patients' anemia and nurses to better treat other medical conditions associated with ESRD.

"Before, nurses had to draw up the drugs and that took a considerable amount of time," he explained. "Now, the nurses can interact with doctors and care for some of the other conditions that patients have, such as diabetes."

Multiple benefits

Adding a pharmacist to the dialysis unit benefits not only patients but healthcare practitioners and providers as well. Nurses, for example, can learn about medication management and dosing by simply observing dialysis unit pharmacists, said Timothy Nguyen, a hemodialysis pharmacist at Holy Name Hospital in Teaneck, N.J.

"Closely watching the administration of medication is beneficial," noted Nguyen, who oversees 210 dialysis patients every week. "Nurses cannot really do medication orders. They do not have a background in medication therapy management, and most of the time they are way too busy. Pharmacists can help the nursing staff with [patient] protocols and medication management. Nurses can learn from the pharmacist."