The Training of On-site Pharmacists: Out-of-the-Box Thinking for Broad Results
A guest blog from Dr Paul Tait, Project Pharmacist Palliative Care and Cancer Services, Rural Support Service
Pharmacists have supported residential aged care homes (RACHs) for decades now. Just as RACHs contract GP practices to provide on-site services for residents, they also contract community pharmacies. Fee-for-service models are already in place, ensuring pharmacists supply medicines, provide clinical pharmacy services and conduct organisational quality improvement activities. While the supply of medications in RACHs has generally worked well, there have been significant challenges in delivering sustainable clinical and quality roles.
In July, the Federal government announced a $345.7 million initiative for employing on-site pharmacists in RACHs. The funding will complement the supply role provided by the community pharmacy, with on-site pharmacists to provide clinical and quality services for residents of the RACH. While the government is yet to finalise the model of how they are employed, the challenges ahead are clear. The challenges include workforce availability, communication with the team, and training. It is the latter that needs some early consideration.
The On-site Aged Care Pharmacist Program symbolises an exciting new career opportunity for pharmacists. However, while the evidence demonstrates that pharmacists working on-site can reduce medication-related problems (MRPs), there is a risk that if left untrained, they could contribute to them. For example, suppose the pharmacist is unclear about the underlying pathophysiology of dementia or the clinical challenges of delivering care into the last days of a resident's life. A broader understanding of these issues would complement their medication knowledge. Fortunately, there is already a range of free and evidence-based training resources available, which organisations delivering aged-care services could adapt to support on-site pharmacists in their role in RACHs.
End of Life Directions for Aged Care (ELDAC)
ELDAC provides information, guidance, and resources to health professionals and aged care workers to support palliative care and advance care planning to improve the care of older Australians. While many of these resources will be helpful in clinical care, some may speak more for the quality roles on-site pharmacists will deliver. For instance, ELDAC has developed an After-Death Audit, providing an opportunity for the RACH staff to reflect on the care provided to individual residents and families. While the audit discusses the role of medications in the terminal phase, it may unearth other issues about the resident's last phase of life towards which medications contribute.
While the End-of-Life Essentials (EOLE) project targets health care professionals in acute hospitals, its modules on health care at the end of life are translatable to the RACH setting. For instance, the EOLE project contains various videos aimed at allied health professionals on how to discuss concerns about death and dying that may arise through their clinical work. While organisations should not expect pharmacists to solve these concerns, how they respond can significantly impact how these concerns develop.
While the caring@home project targets health care professionals delivering home care, its resources describe evidence-based administration of subcutaneous medications. As such, it could be a helpful tool to upskill new on-site pharmacists who lack direct experience caring for residents in the last days of life (terminal phase). In addition, understanding best practices could help pharmacists better understand how their RACHs can deliver timely and agile care into the terminal phase.
Understanding Dementia MOOC
Understanding Dementia is a Massive Open Online Course (MOOC) offering up-to-date university-quality education about dementia research and care. Universities around the globe have developed MOOCs to improve the community's knowledge of a topic or issue. Importantly they are often free and allow participants to explore their perspectives and experiences on the topic. This MOOC addresses the principal issues surrounding dementia, providing opportunities for discussion and networking while learning about dementia.
While this pivot for the pharmacy profession is exciting, it offers organisations opportunities to consider on-site pharmacists' training needs. Whether the responsibility of training may fall upon the individual aged care organisations or others (such as professional bodies or the Primary Health Networks) a range of resources could be used as intended or adapted to support pharmacists as they transition into their new roles.
Feedback on the planned introduction of on-site pharmacists in residential aged care homes closes on the 9 September. Find out more at Australian Government Department of Health and Aged Care ‘Aged Care on-site pharmacists’.
Dr Paul Tait
Project Pharmacist Palliative Care and Cancer Services, Rural Support Service