Commission recommends lifting of RMMR caps

dementia-friendly communities: older hand held by younger hands

Urgent call for pharmacist prescribing rights, embedded pharmacists and more medication reviews after interim report released by Royal Commission into Aged Care

“Shocking evidence” including widespread overprescribing of sedating drugs, often without clear consent, across residential aged care facilities has been detailed by the Royal Commission into Aged Care in its interim report titled Neglect, which was released on Thursday.

The report suggests that as part of 7CPA considerations, the Federal Government, Pharmacy Guild and PSA should review the effectiveness of the Residential Medication Management Review (RMMR) program.

This includes “lift[ing] the cap on funding to enable reviews to be conducted once every year, including when a person enters a residential aged care facility, or otherwise where there is a significant change to the resident’s condition or medication regimen”.

The report calls for RMMRs to include people in respite and transitional care, and for the quality and consistency of reviews to be enhanced.

Negotiations for the 7CPA should also consider further government-subsidised ways to support pharmacists to be involved in the implementation and monitoring of recommendations made during the medication review process, the Commissioners said.

“PSA will act on the suggestions directed to us by the Royal Commission in the interim report. We will do everything we can to ensure residents are protected from the harms medicines are causing in aged care,” said PSA national president, Associate Professor Chris Freeman, in a statement.

“There is no doubt that the absence of regular pharmacist services in aged care facilities is causing harm,” he said.

“Pharmacists are there to keep people safe from medicine-related harm. When you don’t have the right level of investment in pharmacists, this is the outcome which results.”

The interim report found the use of psychotropic medicine was not clearly justified in 90% of cases in which they are prescribed in aged care. 

“This is why PSA has called for pharmacists to work with GPs through collaborative prescribing arrangements. This should be progressed as a matter of urgency,” A/Prof Freeman said.

National president of the Pharmacy Guild of Australia, George Tambassis, said the interim report shows that an urgent response is required from the highest levels of government, and from across the aged care and health sectors.

“Community pharmacists play a pivotal role in providing services and medicines to the growing ageing population, so we have to shoulder our share of responsibility to develop a response that improves the lives of older Australians in care – we are ready to help,” said Mr Tambassis.

“We welcome the acknowledgement by the Commissioners that pharmacists and the Community Pharmacy Agreement should have a pivotal role in addressing the particular problem of the significant over-reliance on chemical restraint in aged care,” he said.

“We stand ready to take part in the proposed review of RMMRs with the aim of ensuring the rules and eligibility requirements for these medication reviews are designed to achieve the best possible health outcomes for aged care residents.”

The Guild recommended pharmacists be provided with autonomous prescribing rights, including the ability to deprescribe, to address some of the issues around the use of chemical restraints, and provide “more timely access” to medicines.

SHPA Chief Executive Kristin Michaels highlighted the report as an important milestone in improving medicines safety for some of Australia’s most vulnerable.

Ms Michaels said getting pharmacists more involved in aged care would be “best achieved through embedding pharmacists directly into the aged care setting, to ensure their expertise is most effectively harnessed to implement recommendations and reduce medication-related harm”.

Embedding pharmacist roles in aged care requires funding and investment both within and beyond existing pharmacy renumeration programs, such as Community Pharmacy Agreements, she said.

“Trialling embedding pharmacists into aged care settings is supported by Commonwealth Chief Medical Officer Professor Brendan Murphy given the benefits demonstrated, and SHPA commends the $3.7 million investment by the Federal government to trial this in the ACT,” said Ms Michaels.

“Further, preliminary Victorian evidence on a clinical pharmacy model in a home nursing service indicated a return on investment of $1.54 for every $1 spent on embedding pharmacists to improve medication management.

“Ultimately, of course, this is all about identifying and managing medication-related issues as early as possible, to improve the quality of life for our older Australians.”

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  1. Ron Batagol

    Ths is an absolute “no brainer”!. I’m sure most of us have, through family situations, seen, or at least heard about, these chronic deficiencies in medication safety and appropriate prescribing! Furthermore, there can be really no worthwhile debate that utiliising the accepted core expertise of pharmacists in this area, to help rectify these deficiencies, is the only way to go! Furthermore, I agree with the Chief Executive of SHPA that “embedding pharmacist roles in aged care requires funding and investment both within and beyond existing pharmacy renumeration programs, such as Community Pharmacy Agreements”. Let’s hope the powers that be, get on with providing the necessary funding for this to happen ASAP!

  2. Why are consultant pharmacists continually left out of the conversation?

    There are plenty of consultants providing “above standard” services to aged care homes for over a decade.

    Antimicrobial stewardship, sedative monitoring, education and training. We were all onto that a few years ago.

    What we need is extra resource to ensure that ALL homes receive this standard of service.

    1. Deliver RMMR differently (on site reviews)
    2. Increase funding for QUM
    3. Enhance the scope of QUM

    Don’t forget the 2000+ strong workforce with industry experience that is best suited to fulfil this role.

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