Is embedding non-dispensing pharmacists the ‘wrong’ approach?

Can non-dispensing pharmacists play a crucial role such as prescribing and advising GPs… or should this role be filled by community pharmacists instead

Pharmacist researcher Dr Janet Sluggett, an NHMRC early career fellow at Monash University’s Centre for Medicine Use and Safety, put forward an argument for integrating pharmacists into aged care facilities before the Royal Commission into Aged Care at a Darwin hearing this month.

“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,” she said in her statement to the Commission.

“Integrating pharmacists within residential aged care facilities will improve provision of medicines information at the point of care.

“In my opinion, 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.”

Dr Sluggett said non-dispensing pharmacists can undertake the following activities to create safer medicines use in aged care facilities:

  1. Comprehensive medication reviews and routine medication chart checks.
  2. Education for residents and family members, facility staff and GPs.
  3. Participation in rounds with GPs to advise on medicines use and resolve medicines-related problems.
  4. Assist residential aged care staff and GPs with medicines information queries.
  5. Collaborative prescribing, in conjunction with GPs, to implement agreed deprescribing plans and monitor/adjust doses of medications that require close monitoring (e.g. warfarin) in accordance with monitoring plans agreed with the GP.
  6. Contribute to antimicrobial stewardship activities.
  7. Administer vaccinations to staff and residents.
  8. Contribute to development of local guidelines.
  9. Review medication incidents, and facilitate audit and feedback activities relating to use of high-risk medicines.
  10. Participate in case conferencing.
  11. Undertake assessments of a resident’s ability to self-administer medicines, and provide ongoing support and assessment for residents who are able to self-administer.
  12. Actively participate in relevant committees, such as medication advisory committees, clinical governance and infection control.

However Pharmacy Guild Acting National President Trent Twomey said embedding non-dispensing pharmacists in aged care facilities would be “the wrong approach”.

“There is no funding for such a model, and no likelihood that funding will materialise any time soon. And even if funded, it would still be the wrong approach,” he told AJP.

“The key is to bolster the connection between local community pharmacies and the aged care facilities, so that the pharmacist dispensing the medication is also the pharmacist overseeing the medication management for the patient.

“Community pharmacies that work with residential aged care facilities have long adopted an approach of translating best practice from the community sector into aged care settings,” said Mr Twomey.

He added that it is important to recognise the importance of Residential Medication Management Reviews (RMMRs) and QUM activities undertaken by pharmacists in collaboration with aged care staff.

“There is currently a real risk of these services being corporatised and delivered remotely,” he said.

Dr Sluggett had highlighted in her evidence that the RMMR program is a “valuable service” and has “provided an extremely important mechanism for pharmacists to provide clinical input into medication management for residents”, however there may be considerable variation in the provision of RMMRs in different facilities.

She also said pharmacists should be more involved than they currently are in the RMMR process and there is a need for more funding.

On the Guild’s position, Mr Twomey continued: “Our view is that wherever possible, the delivery of these services should be directly connected to medicines supply by the local pharmacy, and focus on known medication related issues in residential aged care, including overprescribing, the overuse of medication for behavioural issues in patients with dementia, medicine misadventure and errors during transitional care and support for palliative care patients.

“Of course, these services provided by the local community pharmacist also need to be appropriately remunerated, with clear links back to the patients’ general practitioners.”

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