The Pharmaceutical Society of Australia (PSA) is renewing its call for embedded pharmacists in residential aged care facilities, following worrying findings from the Australian Institute of Health and Welfare (AIHW).
The first quarterly report on the AIHW National Mandatory Quality Indicator Program for residential aged care services since its expansion to include medication management, specifically 'polypharmacy' and 'antipsychotics', shows some concerning findings.
The report revealed that over 40% of residents were prescribed nine or more medications and 50% of those who were prescribed an antipsychotic had no diagnosis of psychosis.
PSA National President, A/Prof Chris Freeman, was deeply troubled by these findings.
"It feels like Groundhog Day when it comes to medicine-related problems in aged care, as worrying data continues to emerge.
"The AIHW report has revealed that more than 40% of Australia's aged care residents are taking nine or more medicines, an indicator that has a direct correlation to medication-related harm and 100% chance that each of those residents have a clinically significant drug interaction.
"With more than 19,000 Australians in residential aged care prescribed antipsychotics with no indication, the level of chemical restraint must be addressed.
"The evidence is clear, the more medicines someone is prescribed, the more likely it is to cause harm. Pharmacists therefore need to be an embedded part of the aged care equation if medication misadventure is to be minimised and rectified.
"As the custodians and experts of medication safety, embedding pharmacists in aged care is the obvious solution to address the longstanding issue of polypharmacy and chemical restraint in aged care facilities.
"This is not speculative, including pharmacists as part of the aged care workforce WILL improve medication management, reduce medication-related harm, and improve quality of life for aged care residents.
"The Government can't continue to beat around the bush on this matter, especially when the lives of Australia's most vulnerable are at stake. The solution to this crisis is right under their noses.
"PSA is once again calling on the Morrison Government to end the neglect by embedding pharmacists in Australia's aged care facilities," he said.
Debbie Rigby, Chair of PSA's Interdisciplinary Team-based Care Community of Specialty Interest (ITBC-CSI), welcomed the expansion of the report to include medication management as a quality indicator, however, she criticised the indicator for grossly underestimating the problem.
"These findings are deeply concerning – but what is equally concerning – is how the data for reporting against the polypharmacy quality indicator is currently being derived.
"The current polypharmacy quality indicator underestimates the true extent of the problem as providers are instructed to report on the number of medicine "products", not the actual number of drugs or active ingredients, a resident has been prescribed.
"If a person is taking a medicine containing multiple ingredients, each one adds to the risk. Not counting them is nonsensical and clearly underestimates the full extent of the problem.
"PSA has been calling on the Quality and Safety Commission to address this flawed measure. In the meantime, residents' lives are being put at risk, and that risk is very much under-reported by this measure.
"The aged care sector has been decimated by the pandemic, and the Royal Commission showed us that there have been systemic problems in the sector for some time. The Government must act now by embedding pharmacists in aged care facilities if we are to save lives and raise the overall standard of care," Ms Rigby said.
PSA strongly supports the program's objectives for aged care providers to have robust, valid data to measure and monitor their performance and supports continuous quality improvement in the care they provide to aged care recipients. Having more accurate measures will go a long way to supporting this.
Background:
PSA's Medicine safety: aged care report found that:
- Over 95% of people living in aged care facilities have at least one problem with their medicines detected at the time of a medicines review; most have three problems
- 50% of people with dementia are taking medicines with anticholinergic properties, which can worsen confusion and other symptoms of dementia.
- One fifth of people living in aged care are on antipsychotics; more than half use the medicine for too long.
The Report from the Royal Commission in to Aged Care Quality and Safety recommended that the Australian Government immediately improve access to quality medication management reviews for people receiving aged care by:
- allowing and funding pharmacists from 1 January 2022 to conduct reviews on entry to residential care and annually thereafter, or more often if there has been a significant change to the person receiving care's condition or medication regimen;
- amending the criteria for eligibility for residential medication management reviews to include people in residential respite care and transition care;
- monitoring quality and consistency of medication management reviews.
The Royal Commission detailed well known issues in medicine management – notably the use of restrictive practices which could not be justified in 90% of cases, and overuse of sedating medicines. PSA has suggested that a flexible practice model is needed to give aged care providers and residents the best access to pharmacist-delivered care, and accreditation of pharmacists entering aged care to perform medication reviews must remain mandatory to support consistent, high quality care.
