Record funding to improve involvement of NSW pharmacists in palliative care will help these “forgotten” health professionals
NSW Health Minister Brad Hazzard has announced record funding for palliative care across NSW, with an additional $100 million to be invested over the next four years, as part of the upcoming NSW Budget.
The package includes $200,000 earmarked for “community pharmacy initiatives to improve medication management for palliative care patients”.
President of Palliative Care NSW Therese Smeal tells the AJP that “you rarely hear pharmacy mentioned in anything to do with palliative care, yet they’re such an integral part of it”.
She says she hopes the inclusion of pharmacy will help address several problems people accessing palliative care often experience.
Patients in end-of-life care in the community often face difficulties accessing adequate amounts of controlled drugs, she says.
“I totally understand why they [community pharmacies] don’t stock large supplies of S8s,” Ms Smeal says.
“But because pharmacists don’t get included in the multi-disciplinary approach and discharge of someone out of hospital to home, people are being sent home with only a certain amount of medicine, maybe three days’ worth if they’re lucky.
“Then there’s rapid involvement from the GP, the family member goes to the pharmacy and they don’t currently stock enough of that medication.”
This is often not a problem if a pharmacy can order it in over a day, but “it’s Murphy’s Law. People get discharged home on the Friday before a long weekend, so it can be Tuesday before a pharmacy is even open,” says Ms Smeal.
“You get there Tuesday and they can’t get stock till Wednesday. So that’s a very logistical issue.
“The other issue is around the need for upskilling of palliative care principles and objectives for pharmacists, so they understand that when a family member comes in with an authority script for a large supply of S8 drugs, what’s going on and how to handle that request.
“We sort of throw pharmacists in the deep end a bit. Many people have no relationship with their local pharmacy – yes, if you’re 75 and take a lot of medicines already, but if you’re a 45-year-old plumber who’s barely filled a script in his life, there’s no relationship with that retail pharmacist.
“So when his wife walks in with a prescription for 10 boxes of 10mg morphine amps, understandably pharmacists may question that.”
She says that many clinicians, including pharmacists, are rather opioid-shy and need to ensure they handle requests around these medicines in an appropriate and understanding manner.
While the suggestion is not part of the NSW funding package, Ms Smeal said that one solution could be issuing a discharge statement for pharmacists and other health professionals, when a person with a life-limiting illness is discharged from hospital, explaining the need for the type and quantity of medication.
“Pharmacists are part of that multi-disciplinary team – and that word runs off everyone’s tongue so easily, but do people apply it?” Ms Smeal says.
“It’s fantastic news that a Health Minister has included pharmacy in this, because they’re so important, and they do get forgotten.”
As well as the community pharmacy funding, the package includes:
- Palliative care training for 300 nurses and allied health staff ($900,000);
- 300 scholarships for rural and regional staff to enhance palliative care skills ($300,000);
- An additional six palliative care specialists in rural and regional areas ($2.4 million);
- Two specialist positions to provide relief to other specialists in rural and regional areas ($795,000);
- An additional 30 palliative care nurses providing care in hospitals, homes and nursing homes ($5 million);
- Community-based palliative care services in Western Sydney, including a 24 hour, seven day a week on-call specialist palliative care service at home ($6.9 million); and
- The development of comprehensive and integrated palliative care services, in line with community expectations and need ($1 million in 2017- 18 as part of a $22 million investment over four years).