Leading pharmacist joins call for colleagues to be integrated in residential aged care facilities – with community pharmacy too separated from the point of care
Pharmacist researcher and PSA’s SA/NT Pharmacist of the Year for 2017, Dr Janet Sluggett, has advocated for the role of embedded pharmacists before the Royal Commission into Aged Care Quality and Safety.
Dr Sluggett is currently the NHMRC early career fellow at Monash University’s Centre for Medicine Use and Safety.
She told the Commission on Friday that “there is an urgent need for a subsidised model of practice which enables pharmacists to be integrated within residential aged care facilities, to provide clinical pharmacy services and support quality use of medicines in residential aged care”.
Non-dispensing pharmacists can undertake a range of activities to improve medicines use in residential aged care, Dr Sluggett said at the Darwin hearing.
These include conducting comprehensive medication reviews and routine medication chart checks, advising staff on medicines, collaborative prescribing in conjunction with GPs, administering vaccinations and more.
There is Australian evidence demonstrating this model of practice improves medicines management in residential aged care, she said.
However she conceded that at present it is “extremely rare” for aged care providers to directly employ pharmacists as members of staff to coordinate or deliver clinical medication services.
Her recommendation echoed comments by Australia’s Chief Medical Officer Professor Brendan Murphy, who told the Commission in May that trials embedding pharmacists in residential aged care facilities have shown “very good benefit” for the reduction of antipsychotics and that embedded pharmacists should be the “highest priority”.
Dr Sluggett told the Commission that community pharmacists often don’t have a lot of information about the aged care residents that they’re packing medicines for.
“Community pharmacists often have very limited clinical information provided to them about the residents for whom they are dispensing medications, and may never actually meet the residents for whom they are dispensing medications,” she said.
“This is different to the traditional model of community pharmacy where patients bring in their prescriptions and pharmacists can easily have a face-to-face discussion with a patient of family member picking up a prescription.
“Integrating pharmacists within residential aged care facility will improve provision of medicines information at the point of care,” said Dr Sluggett.
She added that physical separation between pharmacies, GPs and residential aged care facilities means that each stakeholder can spend a considerable amount of time communicating between each other.
“Some GPs, community pharmacists and aged care providers have excellent and well-established relationships that can facilitate information sharing, but if not, this can be a barrier.”
However she said community pharmacists can have a bigger role to play if falls risk status was placed up front in DAAs.
“A community pharmacist is dispensing a medicine that could be associated with an increased risk of falls, but the community pharmacist may not have any clinical information or knowledge about that resident,” she said.
“And it would be nice for, you know – a community pharmacist could play a role in flagging this person is being dispensed a medicine that could increase the risk of falls. Perhaps you should consider monitoring this resident a little bit more closely in the next couple of weeks to see if they are at an increased risk of falls.”
Counsel assisting Peter Gray suggested that this would be “a very important measure” considering the devastating impact that falls can have on people in aged care, to which Dr Sluggett agreed.