Understanding the Potential for Pharmacy Expertise in Palliative Care: The Value of Stakeholder Engagement in a Theoretically Driven Mapping Process for Research

Abstract

Potentially avoidable medication-related harm is an inherent risk in palliative care; medication management accounts for approximately 20% of reported serious incidents in England and Wales. Despite their expertise benefiting patient care, the routine contribution of pharmacists in addressing medication management failures is overlooked. Internationally, specialist pharmacist support for palliative care services remains under-resourced. By understanding experienced practices (‘what happens in the real world’) in palliative care medication management, compared with intended processes (‘what happens on paper’), patient safety issues can be identified and addressed. This commentary demonstrates the value of stakeholder engagement and consultation work carried out to inform a scoping review and empirical study. Our overall goal is to improve medication safety in palliative care. Informal conversations were undertaken with carers and various specialist and non-specialist professionals, including pharmacists. Themes were mapped to five steps: decision-making, prescribing, monitoring and supply, use (administration), and stopping and disposal. A visual representation of stakeholders’ understanding of intended medicines processes was produced. This work has implications for our own and others’ research by highlighting where pharmacy expertise could have a significant additional impact. Evidence is needed to support best practice and implementation, particularly with regard to supporting carers in monitoring and accessing medication, and communication between health professionals across settings.

Getting palliative medications right across the contexts of homes, hospitals and hospices: protocol to synthesise scoping review and ethnographic methods in an activity theory analysis

“…The review will scope Medline Ovid, CINAHL (EBSCO) and Embase Ovid, Google Scholar and Google Images (seeking organisational flow charts and policies). Keywords and index terms in relevant papers identified in the preliminary search together with stakeholder suggestions49 form the comprehensive search strategy (see online supplemental file 3) for this in Medline Ovid). National Institute for Health and Care Excellence, Department of Health, NHS England (also includes Wales), NHS Scotland and other UK policy data policy database searches will be conducted.…”

“…We will draw on the model of the intended processes developed by Kajamaa et al 10 in their AT analysis of antibiotic prescribing, together with our own provisional model developed from stakeholder engagement in prescribing and using palliative medication 49. Once we have established the range, methods and content of existing evidence we will consider if further analysis is likely to add new interpretations, such as using meta-ethnography techniques 51…”

Palliative Care: A Primary Care Pharmacist Perspective

“…It prevents and relieves suffering, whether that be physical, psychosocial, or spiritual [ 1 , 2 ]. However, the impact of pharmacists’ contribution to the care of palliative patients remains less widely understood [ 3 ].…”

“…Not surprisingly, pharmacists working across all sectors are seen as the hidden and often forgotten arm of any palliative care team [ 3 , 4 , 5 ]. Community pharmacies are based walking distances away from the patients, and pharmacy teams see them and their carers regularly.…”

“…Access to the full medical history and the ability to liaise with all stakeholders allow for establishing the much-desired continuity within the emerging primary-care-access models: pharmacists may act as point of contact for all medication-related concerns. This role is even more significant considering that a growing majority of palliative care patients are cared for in their homes [ 1 , 2 , 3 , 4 , 5 , 7 , 9 , 10 , 11 ].…”