A new era

On 30 April this year, clinical pharmacist Christine Muller became Australia’s first credentialled aged care onsite pharmacist. “Today is graduation day,” Muller tells Australian Ageing Agenda over the telephone. “This aged care onsite pharmacy program is a whole new program.”

Muller, however, has been working in the sector for 17 years. “I did a year-and-a-half before I moved into aged care. I kind of stumbled across the job in aged care and I’ve never looked back.”

She’s spent her aged care career to date at professional services company Choice Aged Care, where she is general manager leading a team of 51 clinical pharmacists Australia wide.

“Choice Aged Care looks after the clinical needs of aged care residents throughout Australia. I’m involved at a clinical level and then also at a leadership operational level,” she says. “My day involves time onsite doing reviews with residents and doing education with nurses. In my role as GM, I do a lot of head office policy reviews, benchmarking and things like that.”

Muller says she likes this variety of the role along with the many rewards working in aged care offers.

“I enjoy the interaction with the residents … and getting to know them as people but then also being able to be involved in their clinical care and improving their quality of life. I love the challenge that aged care brings with a complex disease state where most of the residents have chronic conditions. We deal with cognitive impairments. We deal with polypharmacy, and we do a lot of behaviours and dementia. I love that side of the clinical care.”

Working within a multidisciplinary team of medical professionals is another plus, she says. “On a regular basis, I collaborate with GPs, nurses, nurse practitioners, geriatricians, physios, OTs and speechies.”

It is not without its challenges, which Muller says align with those of aged care homes broadly like workforce. “We need suitably trained and skilled pharmacists to fill these positions.”

She’s hopeful the credentialling program – which supports the government’s program to embed pharmacists in aged care homes from 1 July this year – is a solution to this challenge.

“This is part of our motivation of doing this course and ensuring that the workforce coming out are suitably trained, that they are prepared to be part of the industry, that they won’t just be turners and burners that we see.”

Muller completed the course with CAC’s sister company Pharmacy Care Academy – which three weeks prior to her graduation became the first registered training organisation to receive approval from the Australian Pharmacy Council to deliver an accredited aged care onsite pharmacist program.

Soon after, Muller and two of her colleagues became the first group to undertake the combined aged care onsite and medication management review pharmacist program. She was the first to complete it. CAC is now rolling out PAC’s aged care facility-based credentialling program to the rest of the team.

The course is very focused on industry preparedness

Despite her experience, Muller found the 80-hour hands-on course useful. It involved a mix of face-to-face and online tuition where the majority of the in-person component is work integrated learning.

“The course is very focused on industry preparedness,” she says. “I was presented with the specific quality indicators and benchmarking of aged care. I was involved in a [medication advisory committee] meeting. I was involved in the GP round. I was involved in education with nurses. There was a lot in the course that helped clarify and confirm elements of the program.”

Above: ACOP candidates take part in a real medication advisory committee meeting with seven pharmacists in attendance (left) and a live prescriber’s round consultation (right)

Muller is sure onsite pharmacists will improve medicines safety for residents. Outcomes from CAC’s own pilot of embedded pharmacists among clients has had good results, she says. “We see positives like reductions in polypharmacy and antipsychotic use,” says Muller – who is overseeing the pilot.

She says a typical day for their embedded pharmacist startswith a clinical catch up, usually with the registered nurse looking at what happened yesterday, clinical needs, falls, hospital transfers and other events.

“From there, our pharmacist goes to see anyone who’s returned from hospital and review their meds or anyone who’s fallen and review their meds. And then they will move into the medication reviews and potentially liaise with the GP during the GP round. They’ll generally do some auditing of a particular area and they rotate through the audits.

“In the afternoon, they attend handovers with the care staff and do education around a predesigned topic. And then they’re available for resident meetings. For one-on-one with families, often our pharmacists have their office or their little area they sit in, and the families will come and knock on their door and chat with them as well. It can vary but it is focused around that clinical care.”

Muller is looking forward to the benefits embedded pharmacists mean for the sector. “The whole thing has been hinged on having credentialled pharmacists and we now have credentialled pharmacists. So we are very excited.”

The aged care workforce has reasons to be excited too, she says. In addition to improving care outcomes, onsite pharmacists are trained to assist staff in key areas including quality indicators, handovers and transitions of care events.

“We feel that they will be a big help to not only the residents but to the staff at the facility as well.”

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