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Kidney Week

Abstract: PO0916

Impact of Medication Reconciliation by a Dialysis Pharmacist

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Dyer, Summer, University of California San Diego, La Jolla, California, United States
  • Awdishu, Linda, University of California San Diego, La Jolla, California, United States
  • Rafie, Sally, University of California San Diego, La Jolla, California, United States
  • Nguyen, Victoria T., University of California San Diego, La Jolla, California, United States

Medication reconciliation (MR) improves patient outcomes, reduces cost, and is a reporting measure for the CMS End-Stage Renal Disease Quality Incentive Program. Most dialysis facilities do not have a clinical pharmacist to perform MR. The purpose of this study is to evaluate the impact of a pharmacist performing MR and medication management for patients receiving outpatient chronic hemodialysis at an academic institution.


We conducted a retrospective study from 10/1/18 to 11/2/20 to determine if MR by a pharmacist reduced medication discrepancies (MDs) and medication related problems (MRPs) over time. Secondary outcomes were to describe the type of MDs, type and severity of MRP, impact of a pharmacy delivery service, and number of emergency department (ED) visits and hospitalizations pre- and post-pharmacist integration. Discrepancies were categorized as: unintentional discrepancy, undocumented intentional discrepancy, and MRPs. MRP severity was categorized using the National Coordinating Council for Medication Error Reporting and Prevention index. Descriptive statistics were calculated for each variable and a repeated measures ANOVA test was conducted to determine if MDs or MRPs changed over time.


A total of 135 patients with 479 unique pharmacist encounters were included. The mean (SD) age was 61.7 (14) years, 58% were male, 63% caucasian, mean (SD) time on dialysis 6.7 (6.4) years and most common comorbidities were diabetes and hypertension. The pharmacist conducted 3.5 MR/patient with a mean time spent of 39.7 (16) minutes and 16% required an interpreter. Unintentional discrepancies were noted in 53% encounters, undocumented intentional discrepancies in 71%, MRP in 59% but decreased significantly from the first to the second encounter (1.9 vs 0.9, 1.9 vs 1.2, and 1.1 vs 0.5 per patient, respectively, p<0.05). Most common MRP types included non-adherence, prescription renewals, and excessive drug doses. Over half (54%) were enrolled in a pharmacy delivery service and had significantly fewer undocumented intentional discrepancies compared to non-enrollees (p<0.05). ED visits and admissions pre- and post-pharmacist integration were not statistically different.


Integrating a pharmacist into a hemodialysis unit enabled effective medication reconciliation and management to significantly reduce medication discrepancies and problems, and improve safety.