Pharmacists integrated into home nurse visits

Pharmacists are set to provide medication management support for RDNS nurses, clients and carers under a new East Melbourne initiative

Older people referred for home nursing support who are at risk of experiencing medication errors and adverse medication events will be helped through the new partnership, between Eastern Melbourne PHN and RDNS.

The TEAMM-Pharmacist (Timely Enhanced Access to Medication Management) program aims to improve quality of care and medication safety for older home nursing clients referred for medication management, by providing timely access to a clinical pharmacist who will visit them in their home.

Medication errors occur in up to 40% of this client population, and around 13% experience an adverse medication event requiring hospitalisation or medical consultation.

EMPHN CEO Robin Whyte says older people are at risk of experiencing medication errors and adverse medication events due to having multiple health conditions, multiple prescribers, and multiple medications, and the risk is higher in older people with complex health issues requiring home nursing services.

“The TEAMM-Pharmacist program will integrate clinical pharmacist services within the eastern Melbourne RDNS team in order to streamline access to medication management expertise for clients assessed as being at higher risk of medication misadventure,” she says.

RDNS Institute research fellow Cikie Lee says more than 50% of RDNS home visits are to provide medication management support when people are unable to manage their medicines independently, due to a decline in health and/or cognitive function, or to receiving complex treatments during recovery after hospital discharge.

“The TEAMM program is based on a successful study conducted by our research team that piloted the addition of clinical pharmacists to the home nursing team, to improve interdisciplinary medication management and reduce risk of adverse medication events for frail, at risk older people with complex support needs,” she says.

“The pilot ‘Visiting Pharmacist for Older People Living in the Community (ViP)’ program, conducted in 2014-15, created positive outcomes and influenced changes in medication practice.

She says that nurses visiting older people in homes often face significant barriers including timely access to other health professionals, and that the new initiative is hoped to address this.

“The nurses go out and do a range of support – they give medicines from Webster-paks, or they give injecdtions – and as part of providing these services to our clients they need to interact with a lot of health providers out there, for example GPs and pharmacies, and 40% of our clients are referred by hospitals as well.

“Sometimes the client can be very complex. The average age of a client is about 80 years old, based on our research previously, and on average they took about 10 medicines and had more than five medical conditions. A number of the clients also came from different ethnic backgrounds, such as Greek or Arabic, and this created complexity as well.”

The new program will involve two consultant clinical pharmacists working at the RDNS East Hub to provide medication management support for RDNS nurses, clients and carers, and co-ordinate with clients’ GPs, hospitals, community pharmacies, specialists and other healthcare providers. 

The pharmacists will accompany nurses on home visits with clients to review, reconcile and educate clients/carers on their medicines.

They will work with RDNS nurses, GPs, practice nurses, community pharmacies and other providers to identify and resolve medication-related issues, and optimise medicines use and medication management for at-risk older people.

“When nurses do medicines administration, they often need to refer back to a medicines list, which has to be signed by a prescriber,” Ms Lee told the AJP.

“One challenge nurses face is they find the information in this medicines list not complete, or not clear, so it becomes more complex for them as they spend a lot of time ringing a pharmacist or a GP to clarify these problems.

“Therefore we thought that having a pharmacist to provide a range of services – medicines reviews, medicines reconciliations and other medicines support – would be very useful.

“By integrating the pharmacists with a home nursing team, not only can everyone work better, but they can share knowledge with each other. We all have our different skillsets.”

She says it’s hoped that the projects will see pharmacists help with deprescribing and improving quality use of medicines, which could result in fewer nurse visits.

“Some of the diabetes clients require more than one visit a day – maybe two or three times a day,” Ms Lee says. “The pharmacist can see whether those medicines can be simplified or reduced to once a day.”

The TEAMM-Pharmacist program will target people aged 50-plus who have been referred to RDNS for medication management support and are identified at risk of experiencing medication problems. This will include problems related to treatment complexity, changes in medications, uncertainty as to what is currently being taken, potential interactions and side-effects.

The program will run until 30 June 2018, and is supported by funding from the Commonwealth Government under the PHN Program.

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