When a pharmacist first turned up at an aged care home in Canberra, staff didn’t know what to do with him… but by the time a pilot study ended they were seeking out his help
At the recent ConPharm conference in Brisbane, accredited pharmacist Richard Thorpe, Associate Lecturer in Pharmacy at the University of Canberra Nicole McDerby, and general manager clinical services at Goodwin Aged Care Services ACT Tamra McLeod all presented the results of the pilot.
For six months, Mr Thorpe worked at an intervention site for two consecutive days totalling 15 hours a week (a second, similar Goodwin facility served as a control site).
The hypothesis-generating pilot included a three-month pre-intervention baseline collection period and a three-month post-intervention follow-up collection period.
Acting as a residential care pharmacist, Mr Thorpe performed a variety of activities, such as comprehensive medicines reviews, quality improvement activities, offering pharmaceutical opinions, educating staff, handovers and handling new admissions.
He said that while most pharmacists would be “well versed in and familiar with the role of the RMMR pharmacist, this program provided a whole different perspective on the potential impact an accredited pharmacist can have within an aged care facility”.
He said that many pharmacists would underestimate the understanding facility staff and residents would have about the abilities of accredited pharmacists.
One outcome of the pilot was an increased uptake of staff influenza vaccination uptake, which the researchers said was likely due to the implementation of an in-house vaccination program, as opposed to outsourcing the service.
The residential care pharmacist provided a time-flexible option for staff, which enabled them to access the vaccine efficiently and at times when nursing staff were occupied with other duties.
A total of 85 potential medication related problems were identified and prevented in response to staff or resident enquiry or observation.
The time taken to administer medication to patients was also reduced compared to the control site.
Mr Thorpe told the conference that there were a number of positive impacts he had had on the day-to-day running of the facility:
- there is often little structure to the RNs’ work day, and input from allied health professionals can help make their day run more efficiently;
- despite the current QUM/RMMR programs being in place for many years, aged care staff are not always aware of how to source quality information regarding medicines;
- pharmacists have the ability to communicate effectively with both care recipients and other care providers, which can result in better outcomes;
- staff who administer medicines and come from a non-nursing background are willing to learn how to administer medicine correctly from a pharmacist, and “we need to own this space;”
- continuity of care can be promoted; and
- referrals from OTs, physiotherapists, carers and RNs were made regularly to Mr Thorpe for residents with a range of medication related issues.
Mr Thorpe told the conference that as a residential care pharmacist, he had more time to address the specific medication-related needs of each resident. He was able to manage medication related issues at the home – from receipt, to storage, administration and if necessary disposal.
As well as allowing “real time” interventions, a residential care pharmacist could also help build up strong relationships with GPs, RNs, carers and residents, than when working in the current RMMR framework, he said.
Tamra McLeod spoke about the impact Mr Thorpe had had in a variety of areas, including emergency stock box ordering.
The staff had had ideas about how to improve this, which did not match the supplier pharmacy’s ideas.
So they used Mr Thorpe to help negotiate and work out “what was realistic for us, and what was realistic for the pharmacy as well. So we both came up with a solution that works really really well now.”
It wasn’t just the relationships between RNs, GPs and Mr Thorpe that were improved, either.
“Families would seek Richard out, and residents also, and those relationships didn’t take long to build,” Ms McLeod said.
The researchers concluded that their preliminary findings suggest it is feasible to include a clinical pharmacist in residential aged care teams.