Background:
Allograft transplant recipients require individualised and complex medication regimens. Management is complicated with ongoing dose adjustments, medications with narrow therapeutic indices, and significant drug interactions. With most of the care delivered in the outpatient setting, pharmacists are uniquely positioned to identify, prevent and resolve medication-related problems, as well as to provide education that supports adherence and the safe use of medicines.
Goal:
To evaluate the prevalence and types of pharmacy-led clinical interventions in the outpatient allograft transplant setting.
Action:
Pharmacist resourcing was allocated to support medication management for outpatient allograft recipients at a large metropolitan teaching hospital. The pharmacist participated in outpatient medical rounds alongside physicians and nurses, with the aim of optimising medication safety, conducting comprehensive medication reviews and addressing medication queries.
A retrospective audit was undertaken between October 2025 to March 2026. Medication related problems were classified in accordance with the “Guidelines for pharmacists performing clinical interventions” by Pharmaceutical Society of Australia.
Evaluation:
165 medication reviews were conducted, involving 46 patients. Of these, 89 interventions (54%) were identified. Common interventions were provision of education (27%), compliance-related issues (22.5%), undertreatment (12.5%), and inappropriate dosing (13.5%). Other interventions included the identification of adverse drug reactions (5.5%), medication selection issues (6.5%), unmet monitoring requirements (3.5%) or non-classifiable (9%).
Common interventions included:
Discussion:
Medication-related problems are prevalent in the outpatient setting. The involvement of a pharmacist in post-allograft transplant care enhances medication safety, improves patient education, and optimises clinical outcomes.
The role of the pharmacist has been well received by both patients and the medical team. Future work will focus on targeted stakeholder surveys to assess the value of the pharmacist in outpatient transplant care.