Piloting the role of a pharmacist in a community palliative care multidisciplinary team: an Australian experience

Abstract

BackgroundWhile the home is the most common setting for the provision of palliative care in Australia, a common problem encountered here is the inability of patient/carers to manage medications, which can lead to misadventure and hospitalisation. This can be averted through detection and resolution of drug related problems (DRPs) by a pharmacist; however, they are rarely included as members of the palliative care team. The aim of this study was to pilot a model of care that supports the role of a pharmacist in a community palliative care team. A component of the study was to develop a cost-effective model for continuing the inclusion of a pharmacist within a community palliative care service.MethodsThe study was undertaken (February March 2009-June 2010) in three phases. Development (Phase 1) involved a literature review; scoping the pharmacist's role; creating tools for recording DRPs and interventions, a communication and education strategy, a care pathway and evidence based patient information. These were then implemented in Phase 2. Evaluation (Phase 3) of the impact of the pharmacist's role from the perspectives of team members was undertaken using an online survey and focus group. Impact on clinical outcomes was determined by the number of patients screened to assess their risk of medication misadventure, as well as the number of medication reviews and interventions performed to resolve DRPs.ResultsThe pharmacist screened most patients (88.4%, 373/422) referred to the palliative care service to assess their risk of medication misadventure, and undertook 52 home visits. Medication reviews were commonly conducted at the majority of home visits (88%, 46/52), and a variety of DRPs (113) were detected at this point, the most common being "patient requests drug information" (25%, 28/113) and "condition not adequately treated" (22%, 25/113). The pharmacist made 120 recommendations in relation to her interventions.Fifty percent of online survey respondents (10/20) had interacted 10 or more times with the pharmacist for advice. All felt that the pharmacist's role was helpful, improving their knowledge of the different medications used in palliative care. The six team members who participated in the focus group indicated that there were several benefits of the pharmacist's contributions towards medication screening and review.ConclusionsThe inclusion of a pharmacist in a community palliative care team lead to an increase in the medication-related knowledge and skills of its members, improved patients' medication management, and minimised related errors. The model of care created can potentially be duplicated by other palliative care services, although its cost-effectiveness was unable to be accurately tested within the study.

Clinical networks influencing policy and practice: the establishment of advanced practice pharmacist roles for specialist palliative care services in South Australia

“…7 Despite positive findings from the introduction of this team member to the local service, funding has not been continued and the project pharmacist position not continued. 7 The positive impact of optimal utilisation of the pharmacist has been reported within the palliative care outpatient clinic setting to provide counselling for new drug regimens and provision of a medication summary sheet along with a patient information leaflet. 11 While recognising that specialist palliative care roles have been identified (or mooted) for pharmacists, the use of the term 'specialist' is currently restricted under the national law to the dental and medical professions only.…”

“…7 For a variety of well-described reasons, this population is readily identifiable as being at high risk of medication-related problems and an increased likelihood of experiencing an adverse event. 8 Although community pharmacists need to be informed as and when any patient's health status changes significantly, the medication management issues associated with advanced and progressive life-limiting illness are particularly challenging.…”

“…13 For services that have used a dedicated palliative care pharmacist, the feedback regarding the value of the role has been very positive. 7 The areas identified include improved medication knowledge and the positive impact to change of practice as key outcomes. 7 Despite positive findings from the introduction of this team member to the local service, funding has not been continued and the project pharmacist position not continued.…”

“…7 The areas identified include improved medication knowledge and the positive impact to change of practice as key outcomes. 7 Despite positive findings from the introduction of this team member to the local service, funding has not been continued and the project pharmacist position not continued. 7 The positive impact of optimal utilisation of the pharmacist has been reported within the palliative care outpatient clinic setting to provide counselling for new drug regimens and provision of a medication summary sheet along with a patient information leaflet.…”

“…10 Hussainy et al identify seven key areas where the pharmacist can contribute. 7 (1) Medication review (2) Education for patients and carers regarding specific medicines and modes of delivery (3) Ensuring ongoing access to medications (4) Information provision to team members, particularly regarding 'off label' medicines (5) Consultation and collaboration with team members regarding updating of medication chart…”