Pharmacists, 

Due to the amount of recent medication errors involving dialysis antibiotics (incorrect dose, timing of administration, etc.), we wanted to provide clarification of the expectations for verification of HD medications moving forward. 

When verifying dialysis orders, pharmacists should review the patient's profile for antibiotics (dose, frequency, timing, etc.) and any other medications (BP meds, etc.) that may need to be adjusted based on the patient's dialysis dependency and/or dialysis schedule (MWF vs TThS, supplemental sessions, etc.). This will likely require pharmacists to check nephrology notes to determine the provider's intent. You may follow our P&T- approved renal dose adjustment policy where applicable or contact the physician for orders to adjust medications when needed. 

In order to spread the workload of profile review among our UB/Clin Spec pharmacists, pharmacists should not wait until the patient transfers to the Dialysis unit to verify the HD orders. These should be verified when activated, even if the patient is on the floor. We realize there are some medications with a frequency of "ONCE," so we are in the process of updating the HD PowerPlan to change these medications to "ON CALL." We will also be updating the order comments of the HD medications to specify that they should only be given by a dialysis nurse or while the patient is undergoing HD. This should mitigate any dispensing or administration errors. Until we get the PowerPlan updated, if the patient is not in dialysis at the time of verification, remember to suppress labels from printing to prevent medications from being delivered to the floor.

We have also created a Sentri-7 rule in the Clinical Alerts tab that will prompt pharmacists to perform profile review for patients receiving HD to identify patients who may have been missed or inadequately addressed. 

Let us know if you have any questions about this.