Early adopters of on-site pharmacists highlight the full potential

Early adopters of the on-site aged care pharmacist model are achieving impactful outcomes to better support residents in their medication management with new research highlighting how the initiative can deliver system-level success as well.

Embedded on-site aged care pharmacists in Australia: Insights from early adopters of a new workforce model has just been published by the Centre for Medicine Use and Safety (CMUS) at the Monash Institute of Pharmaceutical Sciences (MIPS)

Key points

• Only 22% of aged care residents have their medication reviewed within three months of admission to a facility, with those reviews typically provided by consultant pharmacists and General Practitioners (GPs)
• In 2022 the Federal Government announced a $345.7 million national rollout of embedding on-site pharmacists in aged care facilities
• Monash University’s research found that embedded pharmacists provided a multifaceted approach to care, typically working as a ‘knowledge broker’ to help move evidence-based recommendations and guidelines into local practice

Aged care residents have often experienced disjointed medication management, particularly as older paper-based systems led to poor communication with healthcare professionals across hospitals, aged care facilities and medical clinics. 

Pharmacists have been among those who have had limited direct exposure to the people they’re prescribing for, resulting in missed opportunities for timely medication management.

“Residents living in residential aged care are commonly on a lot of different medications, complex medication regimens, which can lead to severe medication-related harm, falls, hospitalisations and sometimes even death,” lead author, Dr Amanda Cross, told hello leaders.

“Traditionally, pharmacist involvement has been quite external… There are residential medication management reviews but we know the uptake is limited and they can only happen once a year and only on a GP referral. They can’t be timely if someone started on a new medication, had a medication error and adverse event or returned from hospital.”

Although the Government’s plan to fund on-site pharmacists in aged care facilities has been delayed – it’s expected to begin in 2024 – Dr Cross said several aged care providers and pharmacists have taken the initiative to source funding to provide on-site services. 

As a result, residents now have increased access to expert knowledge and better relationships with their pharmacists. 

“If pharmacists are on site they’re able to have weekly, monthly or sometimes daily conversations and build rapport with that resident. The resident and their family trust that pharmacist and can open up more about things they may not reveal to a stranger who comes in for an annual medication review,” Dr Cross said.

“That also allows the pharmacist to understand the person, their goals of care and ensure their medications are aligned with those goals of care. It also allows them to recognise if something might be an adverse event that may not normally have been recognised if they didn’t know that resident.”

The pharmacists interviewed for the study also shed light on their firsthand experience of working closely with residents. There was an overwhelming consensus that they could intervene quickly if something did go wrong, providing timely advice and support when residents needed it.

“The real key about being embedded there is the frequency of intervention. You can review and talk about and monitor a single resident three or four times in a week if you had to, so particularly if there’s been changes to medications,” explained one of the surveyed pharmacists.

From pharmacist to knowledge broker

The presence of an on-site pharmacist means there is an additional expert to work with when developing or reviewing key facets of clinical governance and quality improvement. Dr Cross said the pharmacist can offer valuable insights for system-level interventions, elevating them to the role of the knowledge broker.  

“There’s a huge scope at that systems level to integrate quality use of medications throughout the aged care organisation and across all levels of staff. This concept of a knowledge broker is where the pharmacist helps to implement new evidence or guidelines into practice and builds the capacity of the staff,” Dr Cross said.

“We know in aged care a lot of stakeholders are off-site so connecting healthcare professionals and making sure everyone’s aware of new guidelines or policies is necessary. There needs to be someone that takes charge of and champions that.”

Dr Cross said the current examples of shared learning can also be used to support and inform providers who will embed pharmacists shortly. Already it appears to be reaping rewards as the pharmacists who participated in the study spoke of their workplace relationships and responsibilities.

“I work very closely with the clinical facilitator across [the organisation]… Policies and procedures, huge area, where they do utilise my knowledge, or I work quite a lot with them in that sort of space as well,” explained one of the Pharmacists in the report.

“I look after governance. I chair the Medication Advisory Committee and Antimicrobial Stewardship Committee. I look after policies too regarding medications. I review regularly policies including diabetes medication management, vaccination policy,” added another Pharmacist.

Given funding is not readily available for on-site pharmacists in every residential aged care setting, Dr Cross said now is a good time to initiate conversations with pharmacists. She said there is a general curiosity about the impact of pharmacists in aged care and for those who want to learn more, reach out to them directly or approach an organisation such as the Pharmaceutical Society of Australia.