Medication review and monitoring of patient's pharmacotherapy regimen | Education and counselling | Disease management programmes | Further tasks |
---|---|---|---|
Taking a thorough medication history, including OTC drugs, herbal supplements, drugs prescribed by non-nephrologists, and CAM drugs | Provision of medical and therapeutic information for patients and other health care professionals | Basic clinical assessments during patient visists | Medication use evaluation |
Medication review at different time points, such as at admission, during inhospital treatment, during each dialysis session, and at discharge | Training regarding the administration of drugs (e.g. ESAs self injections) | Ordering of laboratory tests | Audit measures |
Matching computerised medication profiles with verbally obtained medication history | Counselling on side effects, interactions | Co-ordering of anaemia therapies and other drugs | Â |
Medication order review and checking adherence to prescribing guidelines | Compiling of guidelines for proper drug use (e.g., iron and ESAs) and implementation of treatment algorithms (e.g., hyperlipidaemia, hypertension, and renoprotective drugs) | Co-prescribing within the scope of specific guidelines (e.g., anaemia management or lipid management) | Â |
Development of discharge medication plans | Assessment and monitoring of compliance and adherence | Â | Â |
Identification of potential or actual DRPs | Â | Â | Â |
Therapeutic recommendations (e.g. change of drugs, dose and/or interval adjustments, discontinuation of drugs, additional laboratory monitoring, nephrologist referral, addition of renoprotective drugs) | Â | Â | Â |
Therapeutic monitoring (treatment, laboratory values, and specific drugs) | Â | Â | Â |