Putting pharmacists where they're needed most

Caring for our older population is everyone’s responsibility — a measure of the maturity and compassion of a society.

The health and wellbeing of older Australians living in residential aged care has come under intense scrutiny in recent years, culminating in the Final Report: Care, Dignity and Respect to the Royal Commission into Aged Care Quality and Safety, released in March 2021.

This is for good reason: recent research released by the Office of the Royal Commission found that between 2014 and 2019, hospital admissions from aged-care residents increased by 20%, while emergency department (ED) admissions increased by 27%. More than one-third of all aged-care residents present to EDs at least once a year.

Amid the avalanche of responses that greeted the final report, the crucial role of pharmacy in aged care is undeniable.

Australian research indicates that 91% of aged-care residents take at least five regular medicines, and 65% take more than 10, every day, carrying enormous risk if not managed in a regular, appropriate and considered way.

To this end, the final report’s proposed patient safety measures supporting the inclusion of pharmacists in aged-care settings, underpinned by a new Aged Care Act and immediate review of Aged Care Quality Standards, are warmly welcomed.

Recommendations to provide pharmacy services in all residential aged-care facilities, and embed them in hospital-led multidisciplinary outreach services, were first detailed in the Society of Hospital Pharmacists of Australia’s (SHPA) Standard of practice in geriatric medicine for pharmacy services, released in February 2020. Hospital pharmacists know all too well that a lack of follow-up — through timely and thorough medication review after discharge — can lead to increased readmission, missed medicines or harmful dosing errors. Recent Medicare Benefits Schedule data revealed that as little as 30% of all aged-care residents received a Residential Medication Management Review (RMMR) service.

While the final report from the Royal Commission falls short of recommending embedding geriatric medicine pharmacists in aged care, SHPA welcomes the recommendation for aged-care residents to receive a government-funded RMMR upon entry into the aged-care system, and at least annually thereafter.

This dovetails with recent policy changes to Home Medicine Reviews, which are mostly provided to older Australians, allowing for reviews to be initiated in the hospital setting — a major policy shift for which SHPA has been campaigning for over a decade.

SHPA will continue to advocate for investment in embedding geriatric medicine pharmacists as part of clinical pharmacy services for aged-care residents — including 1:200 pharmacist-to-resident ratios — so pharmacists can identify and manage medication-related issues before they lead to avoidable harm and admission to hospital.

When present in the right place at the right time, pharmacists can identify deprescribing opportunities and foster high-quality clinical handover, which is vital for residents’ wellbeing and quality of life.

Heartbreaking stories were central to the harrowing evidence presented during the Royal Commission’s investigations — the very real personal loss concealed beneath entrenched, systemic neglect.

Personal connection is key to improving Australian aged care. Pharmacists are the health professionals with the knowledge and experience to enact change, to improve the lives of those who have suffered in silence for too long.

Image credit: ©stock.adobe.com/au/perfectlab