Pharmacists and the Aged Care Royal Commission

Critical problems with medication management, including overuse of psychotropic medicines on aged care facility residents were among the findings of the Interim Report of the Royal Commission into Aged Care Quality and Safety last week needing urgent attention.¹

The commissioners found there was a lack of knowledge among residential aged care facility (RACF) staff and GPs about the impacts of restraints and alternatives, and that there had been inadequate funding for residential medication management review (RMMR) programs.

These findings – issued a day before federal and state health ministers made medicine safety a National Health Priority Area – were part of a fundamental overhaul of the design, objectives, regulation and funding of aged care in Australia that the Royal Commission found was needed to correct the failure and neglect in the sector.

In line with PSA’s Pharmacists in 2023 report, the interim report found that pharmacists on the ground in aged care is part of the solution. It also found compelling evidence for a greater role and equity of access for RMMRs. 

The interim report described the aged care system as ‘a shocking tale of neglect’, setting out the extent of the failure of Australia’s aged care services and identifying systemic problems and fundamental reforms needed.² 

The Minister for Health, Greg Hunt, and the Minister for Aged Care and Senior Australians, Richard Colbeck, acknowledged problems raised in the report tabled in federal parliament  on 31 October which have challenged governments, industry and the community over decades.³

ln an unusual step, the commissioners made findings rather than recommendations that will be included in the final report of the Royal Commission but suggested some of them, including reducing the use of psychotropic medicines, needed immediate attention.

On Friday, after federal, state and territory health ministers elevated the Quality Use of Medicine and Medicine Safety to be a National Health Priority, federal Health Minister, Greg Hunt announced: ‘This immediately responds to one of the key findings of the Aged Care Royal Commission’s interim report regarding chemical restraint. Further actions will be outlined in coming weeks.’⁴

The interim report also identified the role the 7th Community Pharmacy Agreement (7CPA) will play in responding to the overuse of psychotropic medicines in aged care, particularly in reviewing the effectiveness of the RMMR program. Use of RMMRs need to be more timely and appropriate, and to extend to people in residential respite care and transitional care, it found.¹

PSA National President, Associate Professor Chris Freeman, said: ‘PSA will act on the suggestions directed to us by the Royal Commission in the interim report. We will do everything we can to ensure residents are protected from the harms medicines are causing in aged care.⁵

‘There is no doubt that the absence of regular pharmacist services in aged care facilities is causing harm.

‘Unfortunately, this is nothing new. PSA’s Medicine Safety: Take Care report identified 98% of people living in aged care facilities have at least one medicine-related problem,’ A/Prof Freeman said.⁵

The Interim Report found the use of psychotropic medicine was not clearly justified in 90% of cases when prescribed in aged care, he said. 

‘That is why PSA has called for pharmacists to work with GPs through collaborative prescribing arrangements.’⁵

Medication-related findings

The interim report found: 

Overuse of chemical restraints, notably psychotropic medicines.

Residents take them for extended periods of time, contrary to clinical guidelines and criteria, and often without consent. There is also a lack of knowledge among staff and GPs about impacts of restraints, alternatives, and safe and appropriate management of the behavioural and psychological symptoms of dementia.

Inadequate funding for RMMR programs for RACF residents.

Current remuneration arrangements can restrict access and there is poor nursing staff recognition of residents who did not receive a RMMR, despite an unmet clinical need. There is also a ‘wide range of interpretations about what adequately constitutes a review,’ and ‘there appears to be a critical gap in eligibility requirements for RMMR’.¹ 

The commission also found there was a need for a subsidised process to support pharmacists to participate in case conferencing, monitor residents’ responses to RMMRs, and implement medicines management plans.

A past Vice President of PSA and Director of NPS MedicineWise, Debbie Rigby FPS, warned that changes to program rules for RMMRs must happen soon, with appropriate funding for pharmacists and GPs.

‘The evidence is strong that pharmacists can reduce inappropriate prescribing of psychotropics through multifaceted interventions (e.g. RedUSe, HALT),’ she told Australian Pharmacist.

‘Embedding pharmacists in aged care will enable better medication management through collaborative medication reviews, education of staff, system-wide improvements such as clinical audits, reducing medication errors, and enhancing communication and collaboration with community pharmacy and allied healthcare professionals.’

The Royal Commission’s recommendations will be published in its final report, expected to be delivered in November next year.

References

1. Royal Commission into Aged Care Quality and Safety. Interim report. Canberra. 2019. At: https://agedcare.royalcommission.gov.au/publications/Pages/interim-report.aspx
2. Media Release. Royal Commission into Aged Care Quality and Safety. Aged Care in Australia: A shocking tale of neglect. 31 Oct 2019. At: https://agedcare.royalcommission.gov.au/news/Pages/media-releases/interim-report-released-31-october-2019.aspx
3. Media release. Interim Report from the Royal Commission into Aged Care Quality and Safety. 31 Oct 2019. At: www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/interim-report-from-the-royal-commission-into-aged-care-quality-and-safety
4. Media release. Mental health a COAG priority. 1 Nov 2019. At: www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/mental-health-a-coag-priority
5. PSA media release. Time for action. 31 Oct 2019. At: www.psa.org.au/time-for-action/