Evaluation of Pharmacist Renal Dose Adjustments and Planning for Future Evaluations of Pharmacist Services.

Clinical pharmacy services are known to improve patient outcomes. Pharmacists contribute to patient care in the acute care setting in multiple ways, including providing advice and information to patients and the health care team, performing medication histories to prevent waste and support medication adherence, analyzing the cost-effectiveness of medications, and ensuring patient safety through patient monitoring and medication review. Specific clinical pharmacist services include managing intravenous to oral medication adjustments, renal dose adjustments, and performing pharmacokinetic dosing of medications, among others. Many of these clinical services are performed daily but are not evaluated for clinical quality or compliance with policies. Evaluating these clinical services may provide a multitude of benefits to pharmacy departments, health systems, and patients. The purpose of this study was to evaluate pharmacist use and percent compliance of a renal dose adjustment policy upon initial order verification and discharge. This was completed through retrospective chart review to determine if dose adjustments were made appropriately and descriptive statistics were used to establish pharmacist compliance. Those orders that were inappropriately adjusted were analyzed for trends that could lead to possible policy improvements or pharmacist education opportunities. The completed evaluation also led to the development of an evaluation system that can be utilized to routinely assess clinical pharmacist services. The results of this study are being used to develop and support future clinical service evaluations, inspire process improvements, and improve patient outcomes and pharmacist accountability.