Introduction: Specialist renal pharmacists are well-established members of the MDT for inpatient wards in the UK. The need for specialist pharmacist services to be provided in the outpatient clinic has grown in recent years to manage increasingly complex drug therapies and more recently, the repatriation of immunosuppression prescribing. This paper describes how the role of the specialist pharmacist has developed in the outpatient clinic at Hammersmith Hospital following its establishment ten years ago.
Core services: It is recognised that the best clinical outcomes are often dependent on good medication adherence. Supporting medication adherence is integral to the clinic pharmacist’s role and they manage a cohort of patients with medication adherence issues. The clinic pharmacist undertakes medication counselling with all new transplant patients and those newly started on immunosuppressants, erythropoietin and other drugs. Relatives, carers and interpreter services will be utilised where language or low health literacy is a barrier to effective communication and the medication support services provided. As an independent prescriber they prescribe new and maintenance supplies of red-listed and other medicines via the home delivery service, outpatient pharmacy and FP10. Medicines reconciliation is regularly undertaken and the pharmacist will often provide GP surgeries with information on medication changes following clinic attendance. Medicines information enquiries are common from staff and patients, can be complex and require a formal literature review. Advice and assistance on managing drug doses following TDM of immunosuppression levels is routinely provided. Major projects such as the switch from branded to generic medicines and repatriation of immunosuppressant prescribing are managed within the clinic by the pharmacist.
Conclusion: The specialist pharmacist is a well-established member of the outpatient clinic MDT caring for renal and transplant patients at Imperial. The role is highly valued by staff and patients and continues to evolve and grow. Clinical practice research is integrated into the pharmacist’s role with a focus on improving clinical outcomes in kidney transplant patients through pharmacist led medication nonadherence identification and support. The research has been presented nationally and internationally and led to collaborative work with other institutions to develop pharmacist led medication adherence research.

Development of the specialist pharmacist role in the renal and transplant outpatient clinic