The Emerging Roles of Pharmacists at Nursing Homes – A journey shared by National Healthcare Group Pharmacy (NHGPh), Singapore

The Emerging Roles of Pharmacists at Nursing Homes – A journey shared by National

Healthcare Group Pharmacy (NHGPh), Singapore

Mr. Chong Jiun Yih, B.Sc Pharm (Hons), MBA,

 Assistant Director, Pharmacy Services Centre,

National Healthcare Group Pharmacy (Singapore)

Why Nursing Homes?

Aging is a known challenge for public health world-wide. In Singapore, the elderly people living alone are likely to increase to 83,000 by 2030 – up from 35,000 in 2012. The rising number of seniors is a cause for healthcare concern as the elderly use more medications than any other age groups and the residents of nursing homes represent the frailest segment of the population. According to the study done by K Mamun et al in 2004ⁱ, the prevalence of polypharmacy in Singapore nursing homes was 60%, of which 70% were found to be associated with inappropriate use of medications. This issue was further complicated by multiple prescribers and sources of medication supply as nursing home residents receive care from various care settings instead of from the nursing home itself. As a result, the medication reconciliation process in a nursing home was often laborious and error-prone. Precious nursing manpower spent significant amount of time to order, housekeep, prepare, and administer medications daily. The manual medication preparation process also increased the potential for medication errors. With all these challenges in mind, NHGPh designed a new care model to address the clinical and operational needs at the nursing homes in 2003.

Professional Pharmacist Services

Today, the pharmacist supports the nursing home clients, providing a full suite of patient care and professional services which include medication review, medication reconciliation, patient counselling, medication safety audit, and provision of drug information and in-service training. All residents’ pharmaceutical care plan in the nursing home will be reviewed by the pharmacist minimally twice a year. On a regular basis, the pharmacist is engaged to conduct medication safety audit which examines the safety and quality aspects of medication ordering, supply, storage, distribution and disposal in the nursing homes. Very often, the pharmacist will be involved in multi-disciplinary discussions with doctors, nurses and other allied health professionals. The pharmacist provides advice on pharmacological treatment and intervenes with evidence-based recommendations.

The pharmacist visits the nursing home weekly to review the new medication orders. Based on NHGPh’s FY2015 data, there were a total of 839 clinically significant, drug-related interventions made for 3855 nursing home beds by its team of pharmacists. Of the 839 interventions, 606 were accepted by the prescribers. Potentially, pharmacists had prevented 72% of the drug-related problems that might harm or affect the quality of life of the residents.

In 2012, NHGPh formed a pharmacist committee that oversees its professional practices in the long-term care sector. Since its formation, the committee has made significant contributions in developing:

•       Pharmacist intervention documentation system that is used to document and analyse interventions done at the nursing homes,

•       Structured training and competency assessment framework for trainee pharmacists,

•       Medication Management Guidelines which was used as a toolkit to implement medication management system at nursing homes, and

•       Drug Utilisation Guidelines which was used as the clinical reference for commonly encountered drugs and clinical conditions at the nursing homes.

Medication Management Services

NHGPh manages the entire medication supply process for the nursing home clients. This includes the procurement and supply of medications for ward stock, emergency kit, and for patients with chronic and acute conditions. In order to streamline the tedious process of preparing and keeping track of multiple long-term medications in nursing homes, NHGPh has been supplying regular, long-term medications using its automated multi-dose packaging system - ConviDose^TM since 2010. ConviDose^TM is a highly personalised medication management service that organises long-term medications into sachets for the individual patient, with the stipulated quantity and time at which the drugs need to be consumed (See attached Figure 1).

Figure 1. Convidose^TM Sachets with descriptions.

This system enables the nursing staff to manage and administer medicines safely, accurately and conveniently. For a nursing home with 200 beds, it was demonstrated that adoption of the Convidose^TM system helped to free up two nursing headcounts which were originally required to prepare medications for administration. With this saving of

resources, nurses can then spend their time on more value-added patient care. At present, Convidose^TM service is provided to 5,860 beds of the 12,000 beds in the Intermediate and Long-term Care (ILTC) sector and the number is expected to rise to 8,246 by March 2018.

Moving forward

As of Mar 2017, NHGPh is providing a range of services to more than 46 ILTC facilities such as nursing homes, destitute homes and day care centres. NHGPh will continue to improve its professional practice standards, explore a new shared care model, and collaborate with nursing homes to improve on the efficiency of medication supply chain. With the success from the nursing homes, NHGPh has also plans to expand its professional and medication supply services to other community partners such as home care and mental health service providers in the near future.