title: Administer but Do Not Dispense: Effect of Change in Medication Handling by Nurses on Outcomes of Home Dialysis Patients.
abstract: To come into compliance with South Carolina statute, we changed how nurses handle medications (antibiotics, erythropoietin [EPO], calcitriol and heparin) in our outpatient home dialysis clinic. Nurses continued to administer medications in the clinic but no longer dispensed medications for patients to take home; instead, medications were dispensed from pharmacies to the patients by mail. We hypothesized that the abovementioned change in medication handling worsened clinical outcomes. There is very little medical literature on this topic.
  
  
  
  A retrospective case series of quality and safety in 31 patients in a community-based, medical center-affiliated home dialysis program was performed. We compared laboratory values and adverse clinical events relevant to the medications mentioned above during 4-8 months before and during 5 months after September 1, 2014 (the day when medication handling was changed).
  
  
  
  We observed no changes in the incidences of dialysis access dysfunction, access infections, antibiotic inaccessibility to patients for access-related infections, infection outcomes, parathyroid hormone concentrations, hemoglobin concentrations, monthly EPO dose and missed monthly clinic visits after September 1, 2014. However, we noted significantly fewer subcutaneous EPO administrations per month and less time between phlebotomy and laboratory review with patients by their nephrologists at monthly clinic visits after September 1, 2014.
  
  
  
  The change in handling of medications by nurses in our outpatient home dialysis program to comply with the state statute did not worsen patient outcomes relevant to the affected medications and in fact caused several unexpected improvements.
authors.affiliation: Division of Nephrology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina. Electronic address: ullianme@musc.edu.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Ullian
authors.affiliation: Division of Nephrology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Martin
authors.affiliation: Division of Nephrology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: David M
authors.initials: DM
authors.lastname: Ullian
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D000554:Ambulatory Care Facilities; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000925:Anticoagulants / Q000008:administration & dosage; D050071:Bone Density Conservation Agents / Q000008:administration & dosage; D002117:Calcitriol / Q000008:administration & dosage; D004335:Drug and Narcotic Control / Q000331:legislation & jurisprudence*; D004921:Erythropoietin / Q000008:administration & dosage; D005260:Female; D006493:Heparin / Q000008:administration & dosage; D006699:Home Care Services; D006801:Humans; D007676:Kidney Failure, Chronic / Q000451:nursing*; D008297:Male; D008875:Middle Aged; D009726:Nurses / Q000331:legislation & jurisprudence*; D010530:Peritoneal Dialysis / Q000451:nursing*; D010594:Pharmacies; D011177:Postal Service / Q000379:methods*; D011787:Quality of Health Care; D006435:Renal Dialysis / Q000451:nursing*; D012189:Retrospective Studies; D012646:Self Administration; D013022:South Carolina
chemical_list: D000900:Anti-Bacterial Agents; D000925:Anticoagulants; D050071:Bone Density Conservation Agents; D004921:Erythropoietin; D006493:Heparin; D002117:Calcitriol
keywords: Erythropoietin; Hemoglobin; Medication dispensing; Peritoneal dialysis