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A new study has emphasised a need for better teamwork between GPs and pharmacists to curb medicine-related harm in residential aged care homes.
Nearly 98 per cent of people in aged care experience at least one medicine-related problem, with up to 80 per cent being prescribed potentially inappropriate medicines.
It's estimated that 17 per cent of unplanned hospital admissions result from inappropriate medication use.
Researchers from the University of Tasmania spoke to 15 pharmacists nationwide who reported miscommunication as a key driver of medicine-induced harm among residents.
"Pharmacists often said that GPs and aged care staff did not accept their recommendations, impeding efforts to improve medication safety in older residents," researchers wrote in the study.
Inappropriate prescribing, polypharmacy and overuse of sedatives were pinned as the most frequent factors contributing to medication-related harm in aged care facilities.
Researchers said that frequent medication reviews by pharmacists could reduce incidents and lower pressure on aged care nurses and staff.
One study found that on-site pharmacists in aged care facilities could lower the risk of medicine harm by 50 per cent and significantly improve patient safety.
But pharmacists reported several obstacles to improving medication safety in aged care, including GPs' resistance in accepting their recommendations.
Infrequent and poorly written medication prescriptions by GPs were causing significant challenges for pharmacists in delivering safe and effective medicines.
Another barrier was a reluctance of aged care staff to accept pharmacist recommendations, which the latter attributed to a lack of knowledge about medications and the deprescribing process.
Families of aged care residents also impeded medication decisions, even when the resident's frailty or other factors warranted a change, according to the pharmacists.
Insufficient funding and inadequate remuneration for pharmacists were the most prevalent system-related barriers hindering improvements in medication safety for aged care residents.
"There's a misconception that pharmacists aim to stop medications completely, whereas their goal is to ensure appropriateness," one interviewee said.
Another pharmacist said, "My main concern is that nursing staff have been given control of medication stewardship programs in residential aged care but lack the clinical understanding or knowledge to apply this in medication management for residents."
The study's findings are particularly relevant as the debate about granting pharmacists independent prescribing rights intensifies.
Autonomous prescribing is where patients bypass GPs and solely rely on pharmacists for diagnosis and medicine prescriptions.
The Australian Pharmacy Council (APC) argued that expanding the role of pharmacists to include prescribing would enhance patient care and improve medication access.
National President of the Pharmacy Guild of Australia, Professor Trent Twomey, said that the pharmacist's ability to autonomously prescribe must become 'a core task for all.'
"Autonomous pharmacist prescribing will improve access to treatment options for patients with conditions that a pharmacist can manage," Professor Twomey said.
But GPs, in particular, worry about granting pharmacists the authority as they believe a comprehensive understanding of a patient's overall health and medical history is necessary.
AMA President Professor Steve Robson said that while he agreed many medication errors boiled down to communication errors, autonomous prescribing was not the answer.
"We believe there's a strong place for pharmacists in aged care practices to check for adverse medication outcomes," Mr Robson told Aged Care Insite.
"But it should be part of a comprehensive general practice model."
Researchers said that all efforts needed to be made to facilitate strong relationships between all healthcare professionals and aged care staff.
Better education, including residents, families, and staff, was underlined as vital to enhancing awareness and promoting safe medication practices.
Importantly, the pharmacists stressed the need for adequate funding to optimise medication management and safety in aged care settings.
They also recommended adequate funding and the use of resources as key factors in improving medication safety in aged care residents.
"By addressing these barriers, pharmacists can play a significant role in enhancing medication management and reducing harm in residential aged care settings."
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Nursing staff in RAC settings have a VERY limited scope of authority in relation to medications [ barring tightly held and controlled Nurse Imitated meds ]
Nurses administer medication that is duly and appropriately prescribed – The reference to ‘reluctance of aged care staff to accept pharmacist recommendations’ is a moot point till pharmacists have the scope of authority to alter prescriptions. When and if that happens Nurses will respond accordingly.
This is a scope of practice grab by the Pharmacy Guild.
RAC sites actively participate and support the RMMR process – these recommendations are tabled with the GP’s – Nurses respond accordingly to any changes that are actioned.
The greatest risk in this process is the lack of overall responsibility of resident care management – with Nurse Practitioners and Pharmacists all altering medication regime – WHO HOLDS THIS ACCOUNTABILITY?