Outcomes of clinical pharmacists with extended prescribing rights in a hemodialysis unit

Recent legislative reforms in Quebec, Canada, have expanded the scope of clinical pharmacists (CPs), allowing them to prescribe medications under specific conditions. While the benefits of pharmaceutical interventions for patients undergoing hemodialysis are well-documented, the specific impact of autonomous prescribing by CPs remains poorly described.

To describe the practice of CPs with prescribing authority in inpatient and outpatient hemodialysis settings and to assess the clinical impact of their pharmaceutical interventions using the CLinical, Economic, and Organizational (CLEO) tool.

A retrospective observational study was conducted at the Centre hospitalier de l'Université de Montréal between February 1 and May 1, 2023. All pharmaceutical interventions were identified and categorized as autonomous or nonautonomous. The CLEO tool was used to assess the CLEO impact of each intervention.

Among 75 patients (mean age 70 ± 14 years; 60% male) across 158 visits, 381 pharmaceutical interventions were recorded, including 89 (23%) performed autonomously. Medication additions frequently involved resumption of previously prescribed therapies, while discontinuations were predominantly proposed to physicians. Major clinical impact was observed across both autonomous and nonautonomous interventions.

CPs with prescribing authority in hemodialysis units demonstrated meaningful clinical contributions across inpatient and outpatient settings. These findings support the role of pharmacist prescribing within multidisciplinary nephrology teams.