2 Development of an integrated palliative care pharmacist role across healthcare boundaries

Introduction The aim of this 3 year project is to develop and evaluate the role of an integrated palliative care prescribing pharmacist, working across different settings to support patients. Methods The pharmacist works within all areas of the palliative care team, including community, hospital liaison and inpatient palliative care unit (PCU). They contribute to multidisciplinary meetings for each of these teams, accepting referrals for a variety of interventions, including complex symptom management, problematic polypharmacy and medication optimisation. The pharmacist visits the patient (at home, in hospital or on PCU) to discuss their medication, suggest possible changes and come to a shared decision with the patient. The pharmacist then works with teams in primary and secondary care, making interventions and suggestions in order to optimise symptom management, reduce undesirable effects and deprescribe futile medication. The patients are followed up and reassessed throughout their journey, monitoring the response to changes. They also support with the education and training of other members of staff within and outwith the specialist team, as well as contribution and development of policies, clinical guidelines, patient information and quality improvement projects. Results From October 2018 to September 2019, the pharmacist reviewed 96 patients‘ medication (individual contacts: 263 contacts with patients, 38 contacts with carers, 166 contacts advising other healthcare professionals). There were 263 medication interventions, including deprescribing of 55 medications. Educational sessions delivered total 20.5hours in a classroom environment (including medical, pharmacy and nursing audiences) and 16 hours supporting Clinical Nurse Specialists during independent prescribing qualification. Conclusion The development of this role has supported the work of the palliative care service, and increasingly been able to provide independent reviews of patients across boundaries of community, hospital and PCU. Going forward, interventions will be assessed further to determine the impact on patient outcomes.