Three week delay in medication for patient with kidney failure
A patient with kidney failure waited three weeks for medication after a specialist dietitian identified exactly what treatment was needed.
Managing kidney disease
Rosalind is a Renal Dietitian working in a hospital in Manchester. She supports patients with kidney failure, helping them manage the complex relationship between food, medication and their nutritional needs.
She identified that one of her patients was experiencing hyperphosphataemia - high phosphate in blood - a common complication of kidney failure that can damage bones and increase the risk of cardiovascular disease if left untreated.
A treatment plan was agreed
Rosalind explained to her patient that the next step to control his high phosphate levels is to start taking phosphate binder medication, which prevents excess phosphate from food being absorbed into the bloodstream. The key to this medication being effective is making sure that the patient takes it with every meal.
“This medication works directly with food and has to be matched with meals. The dietitian is therefore ideally placed to advise and prescribe this following collection of diet history.”
Rosalind spoke to the patient about what type of medication they were most likely to take, such as swallowing tablets, chewing tablets, powder taken with water, powder taken with apple sauce, and worked with him to decide what was best suited to his lifestyle.
“I discussed likely starting dose and numbers of doses per day required based on phosphate intake in diet and meal/snack spacing.”
Dietitians have specialist expertise in nutrition, medication management and behaviour change, making them well placed to support patients with complex conditions such as kidney failure.
Waiting for a clinical management plan
The patient agreed to allow Rosalind to write his prescription, which meant, as a supplementary prescriber, that she had to get a clinical management plan signed off by a doctor before she could start treatment.
A three-week delay to treatment
It took the consultant three weeks to sign the plan, and after that Rosalind wrote to the patient’s GP asking for treatment to be started.
If dietitians were able to independently prescribe not only could the patient have started treatment a lot sooner, but the bureaucracy involved would be reduced.
The impact on patients and services
“The dietitian would be able to hold a larger caseload of patients they prescribe for if they did not have to spend time writing out and chasing sign off of clinical management plans.”
Dietitians are highly trained professionals, with expertise in diagnosing and treating patients within their scope of practice. Independent prescribing would allow specialist dietitians to complete the care pathway they are already leading, improving access to treatment while making better use of clinical time.
How independent prescribing would have changed this case
Once Rosalind had identified the treatment needed, independent prescribing would have allowed medication to be prescribed without a three-week wait for additional approvals.
✅ Earlier access to treatment
✅ Reduced risk of prolonged uncontrolled phosphate levels
✅ No need to spend time chasing signatures
✅ More specialist capacity to support additional patients
✅ Better use of dietetic expertise in medication management
