Embed earlier care, hospital pharmacists tell Aged Care Royal Commission

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 alarmingly high rates of medication-related problems experienced by older Australians, the Society of Hospitals Pharmacists of Australia (SHPA) has recommended.

As part of its submission to the Royal Commission into Aged Care Quality and Safety yesterday, SHPA also calls 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 says 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. 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medicines that should be deprescribed, and implement and monitor deprescribing plans to ensure medicines are safely withdrawn while minimising risk of adverse medicine withdrawal effects.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 says 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. 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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