Table 2:
Outcomes of Pharmacist Intervention
| Pharmacist intervention | Summary (N = 11) |
|---|---|
| Acute kidney injury education delivered, No. (%) | 9 (82%) |
| Medication therapy problem recommendations | |
| Total across all patients on any medication, No. Per patient, median (IQR) |
28 3 (2-3) |
| Indication, No (%) | 11 (39%) |
| Needs additional therapy, No (%) | 11 (39%) |
| Efficacy, No (%) | 4 (14%) |
| Dose too low, No (%) | 4 (14%) |
| Safety, No (%) | 9 (32%) |
| Adverse medication reaction, No (%) | 4 (14%) |
| Dose too high, No (%) | 2 (7%) |
| Laboratory monitoring needed, No (%) | 3 (11%) |
| Adherence, No (%) | 5 (18%) |
| Medication too expensive | 1 (4%) |
| Simplify regimen | 4 (14%) |
| Acted on within 7 days, No. (%) | 24 (86%) |
| Nephrotoxica or renoprotective medication across all patients, No. | 5 |
| Acted on within 7 days, No. (%) | 4 (80%) |
| Discrepanciesb | |
| Any medication across all patients, No. | 14 |
| Nephrotoxic or renoprotective medication across all patients, No. | 1 |
Nephrotoxic medication queried include; acyclovir, aminoglycosides, amphotericin B, carboplatin, ciprofloxacin, cisplatin, colistimethate, cyclophosphamide, cyclosporine, foscarnet, ganciclovir gemcitabine, ibrutinib, ifosfamide, imatinib, irinotecan, lenalidomide, lithium, melphalan, methotrexate (>20 mg per week), mesalamine, nafcillin, non-steroidal anti-inflammatory drugs, oxacillin, oxaliplatin, pamidronate, penicillin, piperacillin-tazobactam, polymyxin, proton-pump inhibitors, rifampin, sirolimus, sorafenib, sulfasalazine, tacrolimus, temozolomide, tenofovir, ticarcillin, topiramate, topotecan, trimethoprim-sulfamethoxazole, valacyclovir, vancomycin (intravenous), zoledronic acid, zonisamide
Active medications omitted, medication listed but no longer being taken, wrong dose of medication, schedule other than prescribed