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Pharmacists need to be embedded into residential aged care as a matter of urgency, say hospital pharmacists

The Society of Hospitals Pharmacists of Australia says that high quality, embedded clinical pharmacy services for aged care residents and the codifying of pharmacist-led medication management services in national standards are urgently needed to reduce high rates of medication-related problems experienced by older Australians.

As part of its submission to the Royal Commission into Aged Care Quality and Safety, SHPA also called for more focus on hospital-standard medication charting, including interim medication charts to smooth transitions from hospital to aged care, increased opportunity for aged care residents to self-administer medicines and increased access to palliative care medicines.

SHPA Chair of Geriatric Medicine Dr Rohan Elliott said early access to clinical pharmacists, with regular and ongoing clinical pharmacist review, for aged care residents is almost non-existent in Australia, placing many at grave risk of medication-related issues.

“In this vulnerable cohort, substandard and unsafe medicines management can lead to medication-related issues that often go undetected until severe illness develops and hospital admission occurs, requiring complex and expensive care by multidisciplinary teams including clinical hospital pharmacists,” he said.

“In many cases, this is highly preventable.

“Recent Australian evidence has highlighted that embedding clinical pharmacist services in aged care can reduce medication-related problems, polypharmacy and adverse drug events, while also being cost-effective.

‘Pharmacists are uniquely skilled to identify medicines that should be deprescribed, and implement and monitor deprescribing plans to ensure medicines are safely withdrawn while minimising risk of adverse medicine withdrawal effects.

“It has also been shown that pharmacists working in residential aged care facilities can help to reduce the use of antipsychotics, an issue that has been prominent in testimonies to the Royal Commission to date.

“Preliminary Victorian evidence on a clinical pharmacy model in a home nursing service indicated a return on investment of $1.54 for every $1 spent on embedding pharmacists to improve medication management.”

SHPA Chief Executive Kristin Michaels said it is well known that older Australians comprise a disproportionate number of the 250,000 medication-related hospital admissions each year, which costs the healthcare system $1.4 billion annually.

“Recent research indicates 91% of aged care residents take at least five regular medicines and 65% take more than ten regular medicines, every day,” said Ms Michaels.

“Other research has shown 96% of residents have at least one medication related problem, with an average of three medication-related problems per resident.

“With appropriate investment into clinical pharmacy services in aged care, applying learning from more than 40 years of clinic pharmacy service delivery in hospitals, the quality and safety of medicines use can be improved and many hospital admissions can be avoided.”

In the submission, SHPA made six recommendations detailing how pharmacists can drive patient-focused services that minimise the risks associated with the use of medicines to optimise health outcomes for older Australians:

  1. Increase access to clinical pharmacy services for aged care residents so pharmacists can identify and manage medication-related issues and reduce harm
  2. Add pharmacist-led medication management services into the Aged Care Quality Standards and Accreditation Standards to mandate the safe and quality use of medicines
  3. Utilise clinical pharmacists to support aged care residents to have more autonomy to self-administer medicines
  4. Utilise hospital-provided interim medication charts to reduce the risk of medication errors related to the transition from acute to residential care settings
  5. Improve the fragmented delivery of aged care services to achieve equitable health outcomes across Australia
  6. Improve access to palliative care medicines for older people in aged care.

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3 Comments

  1. Deirdre Criddle
    07/06/2019

    Embedding Pharmacists In Aged Care is the only way to ensure pharmaceutical care is accessible and equitable for every resident. This should be a QUM right. There has never been a greater imperative. The RMMR model only works intermittently. Making the pharmacist omnipresent could have a real impact on reducing medication-related harm.

    • Jarrod McMaugh
      07/06/2019

      Agreed, and it goes way beyond RMMR and currently delivered QUM services.

      The benefits of a pharmacist on site are manifold.

  2. Penny Kraemer
    12/06/2019

    Some valid recommendations have been made by the SHPA, in particular the use of a hospital-provided interim medication chart. This will improve with the standardisation of discharge summaries and further reduction in discharge summary medication errors, but I wonder what other pharmacists think about their recommendation, based on 20 year old guidelines, around assisting more residents in aged care to self administer?
    I work full time in aged care and have done for 20 years. In the beginning many more residents did self administer, but care needs have increased exponentially and now very few do. In a certain percentage of cases, it has been medication error or non-compliance that has resulted in the admission to a RACF.
    I routinely assess residents who are self administering, often inhalers or eye drops, and find that they are not capable of managing effectively – in the case of inhalers this increases the risk of exacerbations (and hospital admissions) not to mention a reduced day-to-day quality of life. In the case of medicated eye drops, over time this can lead to loss of vision.
    I would like to know on what basis SHPA made this recommendation? I am all for maintaining independence but when that comes with reduced quality of life and medication errors/medication related harm I think we need to assess very much on a case by case basis.

    Also for note, in NSW all RACFs are authorised to hold a full range of medications for use in palliative care as emergency stock so I’m not sure that that recommendation is necessarily relevant?

    The current RMMR/QUM program where QUM contracts can be held by supply pharmacists is contributing to the fragmented system I believe. It encourages a clinical pharmacy service (the RMMR component) that perhaps doesn’t allocate sufficient time to address all aspects of a resident’s medication management and then to subsequently use Education or MAC forums to improve the quality use of medications facility-wide. At each review, if medication trolleys are checked for empty inhalers for example and fridges for inappropriately stored medications, and clinical pharmacists speak to nurses and visit residents in their rooms (on many occasions I find un-charted or expired medications in residents’ rooms that helpful relatives have provided without any understanding of the potential dangers) significant improvements in medication management can be achieved.

    If all clinical pharmacists take the time to engage with nurses and carers when they are onsite and make themselves available for ‘toolbox’ type talks at Nurses’ Stations together with providing laminated flyers etc to assist medication management significant improvements are able to be made.

    Penny

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