clinical focus
treatment authorisation or medication
list to support the client with their
medication administration. This is one of
the key roles of the pharmacist.
At the same time, the pharmacists also
provide other roles for the nurses, such
as answering their questions about drugs,
providing drug information services or
attending the nurses’ clinical meetings to
provide education seminars.
Sometimes, if the nurses had any
questions about the organisation
policy and processes, they would direct
these medicine-related queries to the
pharmacists as well.
So the role of the pharmacists included
everything from supporting direct client
care to indirect client care support.
A spoonful
of sugar
ACI: What were pharmacists asked to do
when nurses referred a client to them?
Visiting pharmacists help
improve medication safety,
says Bolton Clarke.
Cikie Lee interviewed by Dallas Bastian
C
ommunity nurses have been
referring clients to pharmacists
employed by Bolton Clarke to
improve medication safety under an
Australian pilot.
The Visiting Pharmacist study saw
Bolton Clarke employ two part-time
clinical pharmacists to review and
reconcile clients’ medications.
Pharmacists also educated clients and
carers about their medicines, provided
advice and support to community nurses
and worked with clients’ GPs and other
prescribers to optimise medication
regimens and revise or update nurses’
medication treatment authorisation.
The study team reviewed 84 clients
and found the intervention enhanced
medication safety. Under the program,
the pharmacists found an average of
four medication-related problems per
client and an average of two medication
discrepancies in treatment authorisations
per client.
Aged Care Insite spoke with lead author
Dr Cikie Lee, from the Bolton Clarke
Research Institute, to learn more about
the pharmacists’ role and the changes that
were enacted following their reviews.
26 agedcareinsite.com.au
CL: Most of the clients that are referred to
Bolton Clarke, previously known as Royal
District Nursing Service, are high‑risk,
frail, elderly people. Their average age
is about 80–85 years, and they take an
average of 10–30 medications. And many
of the clients referred require medication
support from our nurses, but the nurses
face a lot of challenges with managing
this group because they have a lot of
medication issues.
We created a model in which we
employ in-house pharmacists to support
the nurses. So any client that the nurses
identified as potentially experiencing
medication-related problems, like side
effects with their medication use, or if
any of their medication use – which is
also known as a treatment authorisation
provided by their doctors or GPs – is not
accurate or up to date for the nurses to use
to support medication, they would refer all
these clients for a pharmacist’s review.
Another of the pharmacist’s roles was
to go with the nurses to the client’s home,
often in the presence of a family member
and the carer, to conduct a comprehensive
medication review using a patient-centred
approach, and review and reconcile their
medications and medication lists. They
would also educate the client and discuss
with the family member or carer any
concerns they had about medication use.
After the visit and review, the pharmacist
would provide a medication review report,
and also an up-to-date medication list,
and forward that to the client’s GP to
review and approve.
Often, after the medication lists are
forwarded to the GP and approved,
they can be used by the nurses as a new
How common were medication-related
problems in treatment authorisations?
In our pilot, which was run over 15 months
at two clinical sites of Bolton Clarke, two
pharmacists that we employed saw about
84 clients. Of these, the pharmacists
found that on average they had about four
medication-related problems.
The most common type of medication-
related problem identified by the
pharmacists was clients using potentially
unnecessary medications. For example,
sometimes clients were using two
benzodiazepines, also known as sedatives
– that can cause adverse medication
events in elderly people, particularly falls.
Other medication-related problems
included that they were not compliant
with their medication use. For example,
sometimes they were using a puffer
and taking two doses a day, when in
fact it could have been simplified by a
newer inhaler drug that could be taken
once a day.
Also, sometimes the doses prescribed
for the elderly client by the prescriber are
too high. There were also a lot of other
medication problems as well.
In terms of discrepancies in the
medication authorisation used by the
nurses to administer the medication,
these were often inaccurate. The most
common sort of discrepancy identified
by the pharmacists was omission of
medicine, which means some of the
medicines were not provided in the
medication authorisation by the prescriber.
Or sometimes the medicines listed on
the treatment authorisation, or the doses
prescribed by the GP, were different
from what the clients were actually
taking in their home, or sometimes