Residential care pharmacists: a pilot trial into a novel clinical pharmacy role for improving quality use of medicines in aged care

The aim of this pilot study is to investigate the feasibility of integrating a residential care pharmacist model into the care team within residential aged care facilities. This project is designed as hypothesis-generating research, rather than hypothesis-testing, thus will be used identify potential clinical and operational outcomes for further investigation. This is a cross-sectional, non-randomised controlled trial that will include an intervention period of six months, with a six month preliminary and six month retrospective observation period. This hypothesis-generating pilot study utilises an ethnographic approach to explore the feasibility of the proposed pharmacy practice model. The intervention, being the residential care pharmacist, will operate at the intervention facility two consecutive days per week over the 6 month intervention period and conduct activities under the following categories: Medication review, communication, education, quality improvement, vaccination, and administration. These categories will be administered by the residential care pharmacist as follows: 1. Medication reviews will be conducted through assessment of resident medication profiles to identify scope for rationalising medicines usage, as well as discussion with the residents, care staff or family members to identify any potential or actual issues. Any findings will be discussed with the residents GP. 2. Communication between the residential care pharmacist and the relevant GP, residents, community pharmacy, allied health and nursing staff is to be documented and reviewed with supporting qualitative data derived from surveys and interviews to determine whether communication between these aged care stakeholders is improved under this model. 3. The residential care pharmacist will be responsible for identifying quality use of medicines areas for improvement and develop and deliver 1 hour training sessions for staff. The pharmacist will also be responsible for providing education related to medicines for the residents based on ad-hoc requests. 4. The pharmacist will conduct monthly audits of the medication rooms to review medication storage and disposal practices, and review staff medicine administration practices such as tablet crushing to serve as facility wide quality improvement activities. 5. Influenza vaccinations will be administered by the pharmacist to facility staff and residents consenting to receive the vaccine. 6. The pharmacist will attend and clinical safety and medicines advisory committee meetings to assist in policy development to improve medicines safety at the administrative policy development level. A purposefully designed activity record form will be used to capture all activity data performed by the residential care pharmacist during the intervention period. Residents and staff at the facility will be provided with paper-based surveys to describe their experiences with the residential care pharmacist. Baseline demographic and medical data will be captured by the lead researcher prior to the commencement of the intervention phase at both the intervention and control site. Post-intervention data will be captured by the same researcher at both sites for comparison to baseline, and comparison between sites once the residential care pharmacist service has concluded.