industry & reform
Would the pharmacists be working for the individual facilities?
Onsite pharmacies
Pharmacists should be
embedded in aged care
facilities, peak body says.
Chris Freeman interviewed
by Conor Burke
T
he Pharmaceutical Society of Australia is calling for a
national program that would see pharmacists embedded
in aged care facilities.
A report by the PSA shows that 98 per cent of aged care residents
have at least one medicine-related incident and 50 per cent are
taking one inappropriate medicine.
The PSA national president, Dr Chris Freeman, argues that regular
access to pharmacists for residents and clinicians will help tackle
medical mismanagement and related harm.
“The health of the aged care sector matters a great deal to
pharmacists, and many pharmacists already contribute to activities
and services to improve resident safety and system changes
impacting on quality and safety in aged care facilities,” he said.
In a submission to the royal commission, the PSA also called for
greater education for the aged care workforce, as well as residential
medication management reviews.
Freeman joined A ged Care Insite to discuss how embedding
pharmacists in aged care would work.
ACI: How affordable is it to have an onsite pharmacist?
CF: A lot of the evidence being brought to the royal commission has
focused on medicine management and the issues we are having in
that sector. The reasons for that are multifactorial.
From an affordability point of view, when the commission hands
down its findings and recommendations, there’ll be some pressure
on the government through the aged care division to look at ways of
funding those recommendations being brought forward.
We strongly support the government looking at funding some of
those recommendations targeted towards medicine management.
One of the ideas we have brought forward is pharmacists being
integrated into those aged care settings.
Now, what we’d expect to see would be a pharmacist in those
settings, say, full-time. We expect that this is probably a part-time
role across many of those settings, but we would see an injection of
funding external to the aged care facilities themselves.
16 agedcareinsite.com.au
Well, we’ve got over 32,000 pharmacists registered across Australia,
so we have a ready and capable workforce. Of course, pharmacists
are already engaged at a distance with aged care facilities, providing
medicine reviews and quality use of medicine services. But what we
don’t have is pharmacist time on the ground to assist residents and
aged care staff to manage those medicines.
The way we would see this rolled out would be a flexible model,
knowing that the residential aged care sector has a very diverse
model in which it operates. We wouldn’t expect a one-size-fits-all
approach. We would expect a flexible approach where, on occasion,
it might be a pharmacist directly engaged with a facility. In bigger
aged care facilities, you might see a pharmacist engaged among a
group of aged care facilities, particularly where those facilities might
have a smaller number of beds, for example.
The media has revealed that residents are being given
antipsychotics for longer than the recommended periods, and
that these drugs have little or even detrimental effects. What
are you seeing in aged care currently that is allowing this to
happen, and what needs to change?
Again, the answer is multifactorial. We have an increasing population
now moving into residential aged care, and we have an increasing
burden of dementia and related diseases. We have had a period
where there have been issues with workforce allocation into the
aged care facilities, and unfortunately we see antipsychotics and
sedatives in these facilities being used inappropriately for a number
of those reasons. Particularly around, say, workforce, which are
required to implement some of those non-drug strategies to assist
patients with a behavioural disturbance related to their dementia.
I think with our suggestion of integrating pharmacists into aged
care, what we will see is more time on the ground for pharmacists in
those facilities to help better protect patients from medicine-related
harm, including those from antipsychotics and sedatives.
We want pharmacists to be able to help doctors and GPs make
the right decisions about the medicines at the time of prescribing.
Certainly, at the moment, it’s a very reactive intervention, where the
pharmacist often makes that recommendation to stop or withdraw
that medicine after it’s already been implemented.
At the royal commission, Dr Kathleen Sluggett of the PSA
spoke about some of these issues, including polypharmacy,
where people are taking nine or more drugs. If pharmacists are
embedded in aged care, can they contravene the orders of a
nurse or doctor ?
What we would hope to see is that the pharmacist works very
closely alongside the nursing staff and GPs. Of course, we’ve got
an increasing scope of some nurses working in aged care, and
we really see the role of the pharmacist as working alongside
these prescribers.
As people go through life, they will often develop a range of
chronic diseases, and they tend to collect a lot of these medicines.
Unfortunately, we don’t have a mechanism where we can
comprehensively review over a long period of time that person’s
medicine. What we’re asking is that the pharmacist be embedded
to work alongside those other health professionals to provide
support to them.
One of the future models, potentially, might be that the
pharmacist may have the ability to either step down that medicine,
or stop it completely in a collaborative way, letting the GP and the
nursing staff know as well. n