Home' Australian Pharmacist : Australian Pharmacist May 2015 Contents Australian Pharmacist May 2015 I ©Pharmaceutical Society of Australia Ltd. 71
(the project) has certainly facilitated greater
communication with pharmacists promoting
timely provision of required medications ...
improving client care outcomes.'
-- Regional palliative care service nurse
Thirty surveys were issued with responses
from three nursing directors, four pharmacy
managers, and three GPs. Six responders
(two nurses, two pharmacists and two
GPs) believed the intervention positively
changed the way they delivered services.
One pharmacy manager disagreed with
the hub concept on a commercial basis,
claiming they had lost business as they
were not the hub pharmacy, and that they
historically stocked all the products anyway.
Six (three nurses, one pharmacist and two
GPs) acknowledged the intervention was
effective in improving information sharing
between professionals providing palliative
care. All other responders said they were
unsure if this had been achieved.
Despite designing the trial to value
existing customer-pharmacy relationships,
perceived anxieties about the impact
on pharmacy business surfaced.
Clearly, strategies addressing this tension
need to be considered when rolling
out this model. Reassuringly, while the
dispensing data was limited, it showed the
hub dispensed fewer medicines than any
of the satellites, which challenges these
concerns. In hindsight, the term 'hub'
implies that one business becomes the
'go to' pharmacy for medicines across the
region. A different term such as facilitator
could be used in the future to indicate
the pharmacy that acts as a safety-net for
the others within the region. In addition,
volunteer businesses should be favoured
over targeted selection of pharmacies to
be the facilitator.
Feedback from the palliative nurses
indicates the trial led to better collaboration
with prescribers proactively engaging
with pharmacists, ensuring the medicines
prescribed were also available. While it
is difficult to measure this behaviour
objectively, it is undoubtedly an important
outcome that supports palliative patients
to remain in their place of choice.
There were several limitations to this trial.
Firstly, it was conducted over four months
which is insufficient time to measure
turnover of medicines and sustainability.
A larger study would be required to
identify if this model actually limits expiry
of pharmacy stock whilst maximising
availability of a core list of medicines in a
timely manner. Secondly, there was a poor
survey response rate from GPs. While the
responses received were positive, greater
confidence in these results would come
from a larger sample.
In conclusion, this trial revealed that
pharmacies can work together to
improve access to medicines, although
some anxiety, if unfounded, about
customer-pharmacy relations emerged.
Having a list of medicines available through
community pharmacies guided GPs in
engaging with community pharmacists
where they wished to use formulations
beyond this list. These findings provide
support for conducting larger studies, to
more definitively establish the sustainability
of this model. In the meantime, it appears
both reasonable and pragmatic to facilitate
community pharmacies in working
together to hold a limited range of
medicines, to support timely symptom
control in individuals who which to remain
at home in the last days of life.
References located on page 76.
Table 1. Summary of learning plan for multidisciplinary education about core medicines
A large range of options exist for prescribing
at end of life
Difficult for community pharmacists to
anticipate the range of medicines to stock
Letter of introduction
anticipate in last
days of life
Five common symptoms experienced in
palliative patients include moderate to severe
pain, nausea, dyspnoea, delirium and noisy
Article: Until the chemist
opens: palliation from the
Reasons for selecting each of the five core
Fact Sheet 1, Fact
Sheet 2, Palliative Care
Communication If not prescribing from the core medicines
list, speak with the patient's usual pharmacist
to confirm they can supply their preferred
Support is available from regional palliative
care service and project pharmacist
Fact Sheet 3
Fact Sheet 1: Prescribing guidance for Core Palliative Medicines, Fact Sheet 2: Commonly used resources
for palliative medicines; Fact Sheet 3: Contact List (including telephone and fax details of all community
pharmacies, the regional palliative care service and the project pharmacist).
Table 2. Turnover of core medicines over a four month data collection period
Pack size (no. of injections) Dispensing data (number of ampoules)
Pharm. A Pharm. B Pharm. C
Pharm. D Hospital
Clonazepam 1mg injection
Haloperidol 5mg/mL injection
Hyoscine butylbromide 20mg/mL injection
Metoclopramide 10mg/2mL injection
Morphine 10mg/mL injection
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