Integrating pharmacists in residential aged care facilities to improve quality use of medicine

Integrating of on-site pharmacists in residential aged care facilities to improve the quality use of medicine and reduce hospitalisations of residential aged care residents. a) any physical/informational materials used: Pharmacists will be given training in medications management in aged care and study outcomes. They will be provided with a pharmacist tool kit which provides information on study outcomes and relevant guidelines. b) the procedures, activities, and/or processes used: RACFs in the intervention arm will have a pharmacist integrated into the health care team for 2 or 2.5 days a week (depending on RACF size) for the duration of 12 months. The pharmacist will improve the quality use of medicines through pharmacist activities that are within their current scope of practice as an Australian health professional registered with Australian Health Professional Registered Agency (AHPRA). Pharmacist activities include: • Medication Reviews • Identifying residents at high risk of hospitalisation and prioritising interventions • Vaccination of resident and staff against influenza • Medication reconciliation/review at transition of care • Reviewing and optimising medication rounds • Updating and verifying resident’s clinical information • Answering medication related queries from resident, families and staff • Improving resident’s clinical documentation • Conducting regular clinical audits • Contributing to policies and procedures and education staff about medication management c) what the study involves for participants: RACF residents in the intervention arm will have medication reviews conducted by the pharmacist at transitions of care. This may result in pharmacists discussing medications with residents, and recommendations sent to GPs and other health professionals such as Nurse Practitioners, specialist palliative care, dietitians, and Occupational Therapists. d) the mode of delivery: Face to face. e) the number of times the intervention will be delivered and over what period of time: RACFs in the intervention arm will have a pharmacist integrated into the health care team for 2 or 2.5 days a week (depending on RACF size) for the duration of 12 months f) any strategies used to assess or monitor adherence or fidelity to the intervention (if applicable): The research team will monitor intervention sites for fidelity to the intervention, using two methods informed by Hasson’s Conceptual Framework (2012), that assesses adherence against content, coverage, frequency and duration domains. First, 100% of pharmacist diaries in each intervention RACF will be assessed and cumulative number/proportion of activities will be calculated. Second, a random sample of 10% of intervention RACF medications reviews [of those received a review] will be checked against resident charts by an experienced pharmacist/PI/research team to determine the appropriateness of medications review. Third, interviews with RACF managers/staff and pharmacists will be assessed regarding site buy-in to the model of care, for example, engagement in conducting trial activities. Sites will be given a fidelity rating of high/medium/low based on the assessment.