Embedded on‐site aged care pharmacists in Australia: Insights from early adopters of a new workforce model

Abstract

ObjectiveTo explore the roles of early adopters of Australia's embedded on‐site pharmacist model in supporting quality use of medications in residential aged care facilities (RACFs).MethodsQualitative semistructured interviews were conducted with 15 pharmacists working as embedded on‐site pharmacists, or beyond the scope of traditional consultant pharmacist roles in Australian RACFs. Interviews were audio‐recorded, transcribed and thematically analysed independently by two investigators using an inductive approach. Deductive analysis was also undertaken using a knowledge broker framework: knowledge manager, linkage agent and capacity builder.ResultsDominant themes were roles and benefits of embedded pharmacists, factors associated with success and challenges. Roles and benefits included (1) resident‐level interventions and an enhanced ability to provide collaborative outcome‐focussed resident‐centred care, including timely input and follow‐up, and improved relationships with residents, family and interdisciplinary team; and (2) system‐level interventions such as contributing to clinical governance and quality improvement. Factors associated with success included personal capabilities and approach of the pharmacist, and organisational culture and sector‐wide support. Challenges included pharmacist workforce shortages, perceived lack of pharmacist readiness and difficulty determining an appropriate service model. Deductive coding demonstrated roles of embedded pharmacists were consistent with all three activities of a knowledge broker.ConclusionsThis study highlights the resident‐ and system‐level roles and benefits of embedded on‐site pharmacists, and provides a framework for defining this emerging workforce model in Australian RACFs.

Pharmacists working in residential aged care: a survey of pharmacist interest and perceived preparedness

“…Our study demonstrates that pharmacists felt prepared to engage in both resident- and system-level roles and collaborate with multidisciplinary stakeholders to ensure quality use of medications. This is consistent with the integrated resident and system-level interventions described by Australia’s earliest adopters of the on-site aged care pharmacist model [ 10 ]. Being on-site, the pharmacist has greater opportunity to work with the resident and their families and serve as an advocate to ensure their medication use in line with their personal goals of care [ 10 , 23 ].…”

“…This is consistent with the integrated resident and system-level interventions described by Australia’s earliest adopters of the on-site aged care pharmacist model [ 10 ]. Being on-site, the pharmacist has greater opportunity to work with the resident and their families and serve as an advocate to ensure their medication use in line with their personal goals of care [ 10 , 23 ]. Effective collaboration and communication with healthcare professionals and aged care management staff is also important in driving pharmacist-led interventions in residential aged care, such as antimicrobial stewardships [ 9 , 24 ].…”

“…Medication Advisory Committees). These system-level interventions have been an integral component of the role of early-adopters of the on-site aged care pharmacist model [ 10 ], and are included in the accreditation standards for aged care pharmacist education programs [ 22 ]. In Switzerland, nursing homes with clinical pharmacists are more likely to have system-level structures and processes related to medication use and safety, than nursing homes without pharmacists [ 32 ].…”

“…In Switzerland, nursing homes with clinical pharmacists are more likely to have system-level structures and processes related to medication use and safety, than nursing homes without pharmacists [ 32 ]. Sharing of knowledge between aged care pharmacists [ 10 ], as well as establishing frameworks for transnational collaboration [ 33 ] will be important for upskilling both the national and international workforce for this new role.…”

“…There is growing evidence to support a model of care involving embedded on-site pharmacists in residential aged care [ 9 , 10 ]. In the UK, the Medicines Optimisation in Care Homes MOCH) program involving onsite clinical pharmacists has led to reduction in polypharmacy, hospital admissions and drug costs [ 11 , 12 ].…”