Better use of medication in aged care project updates

Eleven experienced and well qualified pharmacists have now been appointed by the Commission. They travelled to Canberra at the beginning of December 2019 to participate in training prior to beginning work with the Commission’s Pharmacy Outreach Project. 

The training began with a Welcome to Country and Ngunawal yarns, during which Aunty Jannette Phillips shared many aspects of her family’s life and culture. 

Dr Melanie Wroth led the pharmacists through the Design your Care activity to emphasise to us all the importance of ‘identity, culture and diversity’, which was followed by a brief overview of the development and functions of the Commission.

Commissioner Ms Janet Anderson PSM then formally welcomed the pharmacists, before speaking of the importance of the work, and the potential they each have to make a real difference to consumers in the services they visit.

Assoc/Professor Noleen Bennett, Senior Infection Control Consultant at the National Centre for Antimicrobial Stewardship, travelled from Melbourne to meet with the group. She spoke about the value of the Aged Care National Antimicrobial Prescribing Survey and generated strong interest among the pharmacists in encouraging and supporting the services they visit to participate in the survey. 

Dr Wroth then spoke about Restraint and behaviour, illustrating the Quality of Care Amendment (Minimising the Use of Restraints) Principles 2019 with instances from her work and experience. She also explained the scope and aims of the project. 

Dr Lisa Kouladjian O’Donnell from the University of Sydney spoke about the Goal-directed Medication review Electronic Decision Support System, a new clinical decision-making support tool for health practitioners and pharmacists reviewing medications for older patients. The pharmacists were given an opportunity to register pending its release shortly. 

Ms Marie Alford of Dementia Support Australia (DSA) provided a wealth of information in her presentation on supporting non-pharmacological responses when behaviour impacts on care. She explained the assistance available through DSA for advice, consultation and site visits throughout the whole of the country.
 
Ms Sue Edwards drew on her wide experience as a pharmacist educator and provided a practical session entitled A Framework for Successful Professional Communication. She helped identify why educational messages are not always translated into changes in behaviour.

The bulk of the training was presented by Dr Juanita Breen, on the successful Reducing Use of Sedatives (RedUSe) project. RedUSe is a national government funded program to promote quality and appropriate use of sedatives, in particular antipsychotics and benzodiazepines, in residential aged care services in Australia, and to assist with reducing use of these medications whenever possible. The pharmacists have now been trained to deliver this programme and will contact services in remote and very remote locations to offer RedUSe training to nominated Champion nurses and Champion pharmacists. They will offer to explain the programme to community pharmacists and other pharmacists who visit the services and GPs and to assist and support them in any way they can. 
 
The pharmacists all reported that they valued the opportunity to expand their knowledge and network among their peers. They are currently being matched with residential aged care services who have requested to participate and are looking forward to making contact in the near future. 
We are hoping to begin visiting in January 2020. 

One of the Commission’s recently appointed pharmacists, Sue Edwards, and the Commission’s Chief Clinical Advisor, Dr Melanie Wroth, travelled to Port Lincoln for the first visit on 21 January 2020 and spent two days working with staff at Matthew Flinders Home and visiting local GP practices. 

This is the first of the scheduled visits to aged care services in remote and very remote locations to provide education including RedUSe training to nominated Champion nurses, Champion Aboriginal health workers and Champion pharmacists. Three nurses at the Matthew Flinders Home have now been trained and are ready to ‘champion’ reduced use of sedatives at the service. Sue worked with the new Champion Nurses the following day to provide general staff training to a further nine nursing and caring staff – a number of whom came in on their days off to attend. 

The local pharmacist had met with Sue earlier, so he has also been trained in RedUSe to work collaboratively with the staff at Matthew Flinders to deliver the program. 

Sue was also able to discuss antimicrobial stewardship and constipation management among other informal discussions.

Discussion about relevant local issues, access difficulties and challenges faced by staff and residents as a result of being in a remote location, and hearing how these have been or could be solved was an important part of the experience. Melanie is looking to develop an understanding of how things are in these areas and identifying how the Commission can assist in future. It was wonderful to hear about some very positive programs and creative ideas which she is hoping to share. 

Sue and Melanie did not restrict themselves to Matthew Flinders. They visited two of the GP clinics in town, met a range of health providers for informal discussions, and left a number of resources about RedUSe, recent risperidone PBS changes and safe prescribing and deprescribing. 

All services in remote parts of the country have been invited to participate in the schedule of visits – the stars just happened to align early for Port Lincoln. The visits will respond to educational needs identified by individual services.

It is well established that sedatives, such as benzodiazepines and antipsychotics are associated with side effects such as falls, pneumonia, stroke, daytime drowsiness, confusion, reduced interaction and participation in aged care services. Staff at Matthew Flinders are now even better equipped to discuss these issues with consumers and families, and with their agreement, possible changes can then be discussed with the prescribing doctor. 

Thanks to Danielle Green, Director of Care, and staff at Matthew Flinders for enabling such a cordial and successful start to the Commission’s Pharmacy Outreach Project. 

Following its successful start at Port Lincoln, Commission pharmacists and accompanying staff visited Tasmania, Queensland and Western Australia during February. These visits were undertaken under the Commission’s education function to services which had requested the RedUSe training and a range of other pharmacist education. 

Queenstown

Anna McIntyre travelled to Queenstown in Tasmania with Kate Williams and met with the Lyell House community for two days from 5 February 2020. Lyell House is co-located with West Coast District Hospital against the stunning backdrop of Mount Owen and Mount Lyell. 

The Director of Nursing, Lindy Earl-Cooper provided a warm welcome and confirmed that there has been considerable effort already to decrease the use of sedatives in the service, with those consumers prescribed psychotropics only on low doses. 

In addition to training two Champion Nurses, and eight of the nursing staff, Anna spoke with three GPs and the community pharmacist about the RedUSe program in the evening. The group was interested, and the GPs are on board. 

The new Champion Nurses, Ann Liya Antony and Anu Daniel, worked with Anna the next day preparing sedative review plan for two consumers, and the following week we heard from Lindy that three consumers were already on reduced sedative doses.

Esperance

On 10 February 2020 Nicole Frayne was joined by Renee Ruhen of the Commission for ReDUse training at the Esperance Aged Care Facility. 

Nurses Caroline Anderson, Karyln Dummermuth and Jan Fisher were joined by local pharmacist, Nijal Shah for RedUSe Champion training. The next day, a sedative review plan for a resident was initiated at an interdisciplinary meeting, including family members. 

Fourteen staff attended training on the use of sedatives over two sessions. They left the sessions with a deeper understanding of the side effects of antipsychotics and they were all supportive of the RedUse program. Psychotropic prescribing at the service was low, but nurse managers each have a consumer who they are looking at to consider if they can reduce his or her antipsychotic medication.

Swansea

Helena Joseph-Hauser, project pharmacist and Elizabeth Huntly were warmly welcomed by Helen Marshall, Manager of May Shaw Swansea, Tasmania when they visited 13 - 14 February 2020.  

RedUSe Champion Training was provided to Debra Beresford, Khimberly Macapagal and Judy Moore, who are now better equipped to lead May Shaw Health Centre in reducing their use of sedatives, supported by the nursing staff who attended the general education session. The staff put this training to good effect the next day, when they identified a consumer who could be trialled on a medication reduction, explained their reasoning, and prepared a possible reduction schedule. 

The service has a good relationship with Dementia Support Australia and can call on their consultant for help supporting consumers with changed behaviours. 

Thursday Island

Amanda Sanburg, project pharmacist, met up with Kate Williams at Cairns Airport on 9 February for their scheduled visit to Star of the Sea Elders Village on Thursday Island (TI) in the Torres Strait. 

 Amanda delivered RedUSe Champion Pharmacist training to TI Pharmacy pharmacists Caitlin Davies and Michelle Pretorius. The pharmacy supplies approximately 930 blister packs to the Torres Strait outer islands, as well as all pharmacy services to Star of the Sea.  

Residential Services Manager, Belinda Houston, welcomed them to Star of the Sea later that day. There are currently 26 Elders living at Star of the Sea, 13 of whom have varying degrees of dementia. The Elders and staff are all from different islands (see map below). Some of the staff come to work by boat, and both staff and Elders speak Creole. The main community room has sweeping views of the Torres Strait with islands in the distance. Everyone agreed that this contributes greatly to the Elders’ wellbeing. 

Amanda provided an education session on Antimicrobial Resistance, as well as Champion Nurse training to Sam Craig. The only Elder on a psychotropic was relatively new to TI, and following the Champion Nurse training, has been earmarked for a trial withdrawal of this medication.

A second Champion Nurse will be trained remotely on her return from leave. Twenty-two care staff have also been trained about RedUSe. Some of the staff had attended training on Montessori for Dementia,  and identified that both approaches build on person centred care.