Special Issue: Focus on Pharmacy and Formulary
This special issue of Renal News is devoted to renal medications – including what’s being done to help prevent errors, news about our community pharmacy partners, and the latest medications under consideration for the renal formulary. Since medication plays a major role in the lives of all renal patients, these articles will be of interest to renal team members across the province.
Also in this issue, check out the community photos and extensive media coverage from World Kidney Day celebrations across the province (see sidebar articles)!
Ensuring Best Use of Medications for Renal Patients
The Pharmacy and Formulary Review Committee, a standing committee of the Renal Agency, is responsible for improving the appropriate and safe use of medications for renal patients in BC. This includes deciding which medications are on the Agency’s formulary, developing best practice guidelines, and designing a reliable distribution system to make sure renal patients across the province receive their medications.
Click here to read more about the Pharmacy and Formulary Committee
 Preventing Adverse Reactions and Errors through Medication Reconciliation
If you work with renal patients, you may well have run into medication mix-ups, for instance where a prescriber’s medication order isn’t clear or seems to conflict with a previous order. At best, such a situation can take a number of phone calls and a great deal of time to clear up. At worst, medication errors can result in serious consequences for patients.
Here’s where medication reconciliation comes in - a process designed to bring more clarity and precision to medication orders.
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Implementing Medication Reconciliation for BC’s Renal Community
The Renal Agency is committed to supporting medication reconciliation across the continuum of renal care – from clinic, to admission, to transfer, to discharge, and back to the clinic – through refinements to the PROMIS database.
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BCPRA Community Pharmacy Partners
 In January 2008, the Renal Agency awarded new, three-year contracts to 31 community partner pharmacies across the province, including contracts with seven new pharmacies. The new list of community partner pharmacies is available on the Renal Agency website.
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Helping With the High Cost of Medications
 The Renal Agency has a policy of being the "payer of last resort" for medications needed by our renal patients. This means that other payers (federal and provincial governments and private health plans) are expected to pay their usual component first. If money is still owing for any patient medication listed on the Renal Agency’s formulary, the agency steps in. In this way, we remove economic hardship as a barrier to accessing therapy.
Click here to learn more
New Guidelines for Cinacalcet
A new process and guideline for cinacalcet was introduced on April 1, 2008. Click here for the updated criteria and application forms. To coordinate distribution of this expensive medication, all outpatient cinacalcet prescriptions in the province will be centralized at MacDonald’s Prescriptions in Vancouver. MacDonald’s will coordinate compassionate stock (funded by Amgen) and BCPRA-funded cinacalcet. Once a patient has been approved for cinacalcet, prescriptions should be directed to MacDonald’s Prescriptions for processing (fax number 604 876-0242). Initial applications will continue to be processed for approval through the Renal Agency (fax 604-875-7366).
Current Medications Issues
Some of the issues currently being addressed by the Pharmacy and Formulary Committee include:
- Quinine: Both Health Canada and the US Food and Drug Administration have issued warnings that quinine is not to be used for "off-label" indications, such as leg cramps.
- Sevelamer: An increasing amount of negative/null data from clinical trials suggests this drug should be either further restricted or deleted from the formulary.
- Aliskirin: This is the first direct renin antagonist on the market. It may have a role in managing hypertension and reducing proteinuria. The committee is examining whether this medication
- A new erythropoeitic stimulating agent (ESA) has recently been approved for use in Canada and will need to be assessed for use in BC renal patients.
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Anaesthetic creams to reduce needling pain. The suggestion of adding these creams to the formulary comes from patients who experience needling pain on dialysis. Before making such a change, however, the committee must address a number of questions, such as: If anaesthetic creams were part of the formulary, could we afford them? Do they really reduce needling pain? Would they be used appropriately? Would fewer patients choose catheters if anaesthetic cream helped overcome their fear of needling pain?
Profile in Kidney Care
The Challenges and Rewards of Pediatric Pharmacy
 In her 25 years as a pharmacist, Kathleen Collin has worked in a wide range of clinical settings and jobs, but she says few have been as rewarding as her current position. Kathleen has been the pediatric pharmacist for the renal program at BC Children’s Hospital since April 2007, and although she enjoys her job, it is not without its challenges.
One of the most basic challenges of pediatric pharmacy involves simple communication. "With young children," says Kathleen, "you can’t always expect your patient will be able to tell you what you need to know."
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Links to other information
More information and other resources about renal medications and the formulary are available from the links provided below:
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