Clinical Pharmacy Nephrology Practice in the Outpatient Dialysis Center

Outpatient dialysis centers are a prime environment for clinical pharmacy intervention. Opportunity abounds for patient outcome-focused intervention such as intensive compliance counseling, drug-interaction screening, evaluation and interpretation of drug level assays, teaching (staff, physicians, patients), and enhanced overall medication management. Nephrology pharmacy is a relatively underdeveloped specialty practice, with clinical pharmacy practice in outpatient dialysis centers comprising a very small segment of that practice. There are many topics of concern that show a need for further evolution of this practice: polypharmacy, patient compliance, expensive medications (ie, recombinant human erythropoietin [rHuE-PO]), and Medicare End Stage Renal Disease (ESRD) program reimbursement constraints. In this report the origin and current status of the pharmacy nephrology service at St. Joseph Hospital and Health Care Center in Tacoma, WA is described.