Review can inform onsite pharmacist program

A Monash University Centre for Medicine Use and Safety review can help guide the system-level roles embedded aged care pharmacists need to improve evidence-based care, says the lead author.

A systematic review has found that knowledge brokers improved adherence to clinical practice guidelines in health-related settings in two-thirds of studies.

Knowledge brokers – an emerging role pioneered by Monash University in response to poor uptake of recommendations in clinical practice guidelines – are individuals or groups that facilitate implementation of new knowledge, evidence and guidelines into practice.

The review is part of the EMBRACE study – a collaboration with five different aged care provider organisations in Victoria, New South Wales, Queensland and Western Australia involving embedded pharmacists acting as knowledge brokers to improve medication safety.

“It is helping to define our intervention, which will involve onsite aged care pharmacists acting as knowledge brokers to implement new Guidelines for Appropriate Use of Psychotropic medication,” lead author of the review and EMBRACE study investigator Dr Amanda Cross told Australian Ageing Agenda.

The review can also inform the Australian Government’s rollout of on-site embedded pharmacists in residential aged care by guiding the system-level roles pharmacists will need to undertake to ensure facility, organisation and sector-wide improvement in evidence-based care, she said.

“Currently pharmacist engagement in aged care, namely medication supply and medication reviews, is mainly resident-level. The onsite embedded pharmacist model – which is due to start this year – has the potential to drastically improve medication use in residential aged care, if the role is designed well. We think it’s important that the role includes both resident- and system-level services, and the knowledge broker framework could be used to define those system-level roles,” Dr Cross told AAA.

As described in the review, the system-level roles of pharmacists include knowledge manager, linkage agent and capacity builder.

“Pharmacists would act as a knowledge manager by integrating new guidelines into the policies and procedures of residential aged care to improve delivery of care in line with the latest evidence,” Dr Cross said.

“Pharmacists will be the linkage agent for the numerous internal and external stakeholders that need to communicate in order to achieve quality use of medicine. It will also be important that embedded pharmacists communicate, or link, with each other to allow for mentoring, peer support and sharing of best practice between residential care facilities, especially in regional and rural Australia,” she said.

“Finally, pharmacists will be wellplaced to build the capacity of aged care staff to support medication safety, through education and formal audit and feedback of quality improvement initiatives,” Dr Cross said.

The full review has been published in the healthcare journal BMJ Quality & Safety: Roles and effectiveness of knowledge brokers for translating clinical practice guidelines in health-related settings: a systematic review

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