clinical focus
different frequencies. There were a lot of other medication
discrepancies as well.
These medication issues are taking up a lot of nurses’ time
in the home when they go out and provide medicine support
visits. So instead of doing 20-minute visits, sometimes they need
to stretch to 30–45 minutes, just to sort out all these issues,
including contacting the d octors or pharmacy for clarification,
or sometimes they need to wait for them to respond.
What changes to medication use were enacted? What did the
pharmacists’ reviews bring about?
When the pharmacists identified a potential problem with
client medication use, they provided recommendations in their
medication review report to the GP.
Some of the common recommendations made by the
pharmacists included inviting the doctor to consider adjusting
the dose. For example, if some of the elderly are taking anti-
depressants, but the dose prescribed by the doctor is higher than
what is recommended by best practice guidelines or references,
they would advise the doctor to consider reducing it.
Sometimes the pharmacists recommended ceasing medications
such as sedatives or benzodiazepines, like sleeping pills, which are
actually not recommended to be used in the elderly because of
risk of falls.
Other changes included the pharmacists advising the doctor to
adjust the dose timing. For example, if a client is taking a night-
time medication, it requires a nurse to go out for a night visit, so
the pharmacist would ask if the medication could be switched to
a morning dose to reduce the nurse’s evening visits.
What impact could more pharmacists’ involvement in
community care have on the health of older Australians?
We are facing an ageing population, and there will be more elderly
people requiring home support. There’s also an increase in the
drugs available nowadays, and there’s improvement in the health
services provided, which means that more elderly people will be
taking more medications, and seeking more health services, and
seeing multiple doctors and specialists.
One of the challenges is there will be a lot more medication
issues and problems coming up. And therefore we foresee that
more elderly people will be referred to home nursing services for
medication support.
So by having a pharmacist working alongside the nurses, this
is a model that can improve interdisciplinary teamwork and
collaborative teamwork in medication management, where it
would improve medication safety for the clients. Often, improving
medication use can translate to better outcomes in other areas,
which means the elderly can have a better quality of life. They are
less likely to go into hospital, and less likely to call for emergency
visits. Also, they are less likely to consult doctors for unnecessary
medication issues. Therefore, this could potentially translate into
cost savings for the healthcare system.
In terms of the nurses, this model could benefit them by giving
them access to better teamwork support.
The pharmacist model we created is a new model of
clinical pharmacy. It only exists in hospitals, where you have a
multidisciplinary team – nurses, GPs and pharmacists – working
together to provide support to elderly patients. In a community
setting, nurses often work alone. So by having a pharmacist working
with them, that could enhance teamwork and relationships with
GPs and the hospital community interface. ■
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