Am J Kidney Dis. 2020 Sep 10:S0272-6386(20)30941-0. doi: 10.1053/j.ajkd.2020.07.021. Online ahead of print.
Medication-related problems are a leading cause of morbidity and mortality. Patients requiring dialysis are at a heightened risk of adverse drug reactions because of the prevalence of polypharmacy, multiple chronic conditions, and altered (but not well understood) medication pharmacokinetics and pharmacodynamics inherent to renal failure. To minimize preventable medication-related problems, healthcare providers need to prioritize medication safety for this population. The cornerstone of medication safety is medication reconciliation. Here, we present a case highlighting adverse outcomes when medication reconciliation is insufficient at care transitions. We review available literature on the prevalence of medication discrepancies worldwide. We also explain effective medication reconciliation and the practical considerations for implementation of effective medication reconciliation in dialysis units. In light of the addition of medication reconciliation requirements to the Centers for Medicare and Medicaid Services End-Stage Renal Disease (ESRD) Quality Incentive Program, this review also provides guidance to dialysis unit leadership for improving current medication reconciliation practices. Prioritization of medication reconciliation has the potential to positively impact rates of medication-related problems, as well as, medication adherence, healthcare costs, and quality of life.
PMID:32920154 | DOI:10.1053/j.ajkd.2020.07.021