The introduction of dietetic supplementary prescribing in the renal dialysis population in the management of Chronic Kidney Disease-Mineral Bone Disorder (CKD-MBD)

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Background & Problem

Renal dietitians have the skills to advise on bone mineral medications but until recently have not been able to prescribe these medications. Patients often require a second consultation with a prescribing clinician to initiate the dietitians plan, causing frustration and delay for all involved. Legislation changed in 2016 to allow dietitians to become supplementary prescribers and we aim to evaluate this change in service delivery.

The project was carried out within GHNHSFT Renal Service, including haemodialysis patients cared for by 2 prescribing dietitians. The QI team included Nephrologists, Renal Pharmacists and the Renal Dietetic team.

Aim

To introduce dietetic supplementary prescribing with the aim of reducing the time required for patients to receive new medications for the treatment of Chronic Kidney Disease – Bone Mineral Disorder by 50% in 6 months.

Method

• Number of days from a new medication being recommended by the renal dietitian, to the dispense date of the medication from the hospital pharmacy was measured.
• Retrospective data was collected prior to dietetic prescribing and intervention data was collected prospectively for 6 months once dietetic prescribing had commenced.
• Exclusion criteria: patients receiving a prescription from a primary care pharmacy.
• Serum calcium, phosphate and parathyroid hormone levels were recorded to assess patient outcomes.
• Patient experience before implementation of dietetic prescribing was measured via a questionnaire approved by the hospital patient experience team.

Results

• Median time to prescriptions reduced from 13 days to 1 day. This was a 92% improvement in process following the introduction of dietetic supplementary prescribing.
• Biochemistry improved in 92% of patients compared to 63% improvement pre-intervention by month 1.
• Satisfaction survery pre-intervention confirmed patients believe there is time delay following dietetic recommendations.

Implications

Dietetic supplementary prescribing improves time taken for patients to receive medications for the treatment of CKD-MBD and this has led to improved related biochemistry as a secondary outcome. This could lead to delayed disease progression.

Advanced dietetic roles can reduce unnecessary clinician contacts for the sole purpose of accessing medicines and provides opportunity for service re-design.

Delivering an efficient service for the management of long term conditions where diet, lifestyle and medicines are key features, has the ability to improve patient experience and utilise dietitians with advanced skills to facilitate service improvement.