How valuable is the work that a residential care pharmacist could do? And should prescribing in this role be considered?
University of Canberra researchers have provided case studies that reveal the practical impact that pharmacists embedded in residential aged care homes could deliver.
Transitioning from community or hospital into residential aged care homes has been identified as a particularly high-risk point for medication misadventure, say the authors in this month’s issue of the Journal of Pharmacy Practice and Research (JPPR).
Approximately 20% of residents experience significant delay in medication administration and missed doses following transfer to a home, according to Australian data.
During a six-month trial in 2017, pharmacist Richard Thorpe was employed part time at a Canberra residential aged care home.
As a residential care pharmacist, Mr Thorpe provided an in-house pharmacy service as opposed to the more common consultancy-based visitational role.
This allowed enhanced follow-up with residents, and more frequent face-to-face collaboration between the pharmacist and care team.
During his trial, Mr Thorpe also provided influenza vaccinations in addition to conducting medicines reviews, quality improvement activities, offering pharmaceutical opinions, educating staff, handovers and handling new admissions.
One of the cases that Mr Thorpe was involved in concerned a resident who had recently transitioned from hospital.
The residential care pharmacist identified that the resident had not received any warfarin doses since arriving at the home several days earlier, due to the medicine being prescribed ‘when required’.
Without review, the resident may have remained inappropriately anticoagulated for a further four days until the next anticoagulation review, and as she had atrial fibrillation this led to a higher risk of thromboembolic event.
In a second case, pharmacist review was requested for a resident due to increasing difficulty in administering medications and increasing anxiety around personal care.
The pharmacist identified that the resident was likely in pain due to inadequate regular analgesia (paracetamol only) when she previously required fentanyl patches, which may have been contributing to her distress.
She was commenced on transdermal buprenorphine and continued on liquid morphine due to difficulty swallowing and opioid naivety, with oxycodone ceased due to risk of opioid toxicity.
Further scenarios were discussed in the JPPR paper.
“The ability of the residential care pharmacist to conduct timely medication reviews and follow-up with residents as needed to ensure that recommendations were followed may have prevented serious adverse outcomes, such as pulmonary embolism, stroke, haemorrhage and opioid overdose,” found the authors.
“The cases reported herein demonstrate that positioning pharmacists in residential aged care homes helps facilitate safer transitions of care and reduces the incidence of preventable medication errors and associated adverse outcomes.”
They add that as pharmacist scope of practice expands, some of the errors averted in the case series may have been corrected earlier if the residential care pharmacist could prescribe.
“Further investigation of pharmacist prescribing in residential aged care homes is warranted,” the researchers conclude.