Development of a clinical pharmaceutical service promoting active ageing

Abstract

Introduction: As life expectancy is increasing worldwide, physical and psychological optimisation of care for older persons is receiving greater attention. Quality of life considerations take particular significance in ageing healthcare best practices. The older population is susceptible to a multitude of co-morbidities due to polypharmacy. Clinical pharmacists' cont ribut ion include detection and mitigation of drug-related problems (DRPs) which are more likely to happen in patients with co-morbidities especially due to polypharmacy. The aim of the study was to develop and implement a clinical pharmacy service within a long-term care facility for the elderly supporting active ageing. Method: Phase I involved identifying standards of practice for geriatric clinical pharmacist service to meet needs of longterm care wards. Two weeks of observation (Phase I) in the long-term care wards were dedicated to identify the gaps by completing a Gap-Finding Tool for Active Ageing by the pharmacist-researcher. Phase II consisted of the development and validation of Patient Medication History on Admission and the Pharmacist Patient Profile tools, to be used in the clinical pharmacy service. Phase Ill consisted of attending four wards, chosen by convenience sampling, in the long-term care facility over 8 weeks and documenting pharmacist interventions. Patients included in the study were over 65 years of age and without cognitive impairment. Treatment for each patient was reviewed and problems in drugs prescribed were noted. Interventions carried out by the cl inical pharmacist and communicated to prescribers and to patients were classified according to the PCNE Classification for Drug-Related Problems V9.1. Phase IV analysed the impact of the geriatric clinical pharmaceutical service among prescribers and nurses by the administration of a post-clinical service questionnaire. Phase V analysed recommendations for improving the service based on the findings from the study. Results: Twenty-one practice guidelines, out of seventy-eight, were not being carried out at the long-term care wards. The rest of the practice guidelines were being fulfilled by other healthcare staff in the absence of a pharmacist. The Patient Medication History on Admission tool was used twice and the Pharmacist Patient Profile tool was used 40 times over the Pharmacy Education 25(4) 1 - 121 Hospital pharmacy course of 8 weeks. The study population consisted of 40 patients, with a mean age of 83 years. The mean number of medications per patient was 13, the total number of DRPs identified was 126, with 240 interventions suggested by the pharmacist of which 74% were accepted and fully implemented. Drug selection was the most common cause of DRPs (n=48). Seven out of eight healthcare professionals were very satisfied with the service, while one was satisfied. Frequent medication reconciliation and reviews are recommended to prevent DRPs. Conclusion: A clinical pharmacist engaged in geriatric longterm care setting can regularly check for interacting drugs and contraindications, assess appropriateness of drugs prescribed and optimise and personalise pharmaceutical care plans. DRPs and adverse reactions are reduced with the participation of a clinical pharmacist. Additional research could include assessing severity of DRPs identified.