Identifying patients on haemodialysis potentially suitable for deprescribing

Jack E. Dickin

MPharm, AdPhaM | Resident, Royal Hobart Hospital | jack.dickin@ths.tas.gov.au

[Pharmacy GRIT article no: 20241409]

During my Residency Training Program, one of the most significant challenges I faced was juggling a research project outside my primary area of practice with the various requirements of my residency program. My project focused on deprescribing in patients on haemodialysis: a patient group that experiences among the highest rates of polypharmacy, increasing the risk of medication-related complications. I conducted an audit to identify patients taking potentially inappropriate medicines who could be eligible for deprescribing, using validated pharmacist-developed algorithms tailored to this medically complex patient cohort.1

When planning my residency, I looked forward to a breadth rotation in the inpatient renal unit to enhance my renal knowledge and integrate it into my research. However, as my residency progressed, I accepted an exciting opportunity to work in an oncology/haematology specialist role which proved to be an invaluable learning experience — but came with challenges that impacted progress with my research project.

Overcoming the challenges and reaping the rewards

I had not previously been required to complete ethics and research governance applications for my Masters capstone project so working through these forms and applications for the first time was overwhelming. I found it hard to stay focused as working in a different specialty made it difficult to see how the work related to renal patient care. The day-to-day responsibilities of my new role and the stress of navigating a more demanding position drained my motivation. It became increasingly difficult to maintain focus on my project despite background reading on deprescribing being informative and engaging.

A turning point came when I began auditing the patients and discussing findings with my supervisor. Engaging with the data and reflecting on the real-world benefits of deprescribing helped me rediscover my motivation. Regular meetings with my supervisors kept me accountable, providing the encouragement I needed to push through the challenging phases of my research.

Presenting the findings to the local renal team was a particularly rewarding experience, sparking meaningful discussions amongst the medical team and outpatient specialist pharmacists that really highlighted to me their core role within the team. This experience underscored the importance and impact of pharmacist-led interventions in improving patient care and it was really fulfilling to receive feedback and promote discussion.

 Where to from here?

Now that my project is complete, I am eager to start a secondary project: implementing the deprescribing algorithm within our centre. I genuinely hope that this initiative will further showcase the role of pharmacists in leading deprescribing measures within specialised and complex patient populations. I feel much better prepared for what lies ahead, particularly ethics and research committee submissions and juggling workload pressures.

This research journey has been one of growth and learning. I have deepened my understanding of the vital role pharmacists play in patient care, especially in managing complex medication regimens. I have become more adaptable, independent, and resilient. My ability to appreciate real-world outcomes of research has deepened and along with it my ability to self-motivate to achieve meaningful results. I am excited about the opportunity to translate my research into practice, improving the lives of patients on haemodialysis.

Acknowledgements

I would like to acknowledge my project supervisor Danielle Watson (Specialist Pharmacist Renal Outpatients, Royal Hobart Hospital), my residency mentor Caitlan O’Keefe (Pharmacy Educator, Royal Hobart Hospital), and Residency Program Director Brodie Hose (Pharmacy Educator, Royal Hobart Hospital).

References

  1. Lefebvre MJ, Ng PCK, Desjarlais A, McCann D, Waldvogel B, Tonelli M, et al. Development and validation of nine deprescribing algorithms for patients on hemodialysis to decrease polypharmacy. Can J Kidney Health Dis 2020; 7: 1–10.