By Susan C. Jenkins

Seniors use more prescription medications than any other group in Canada, partly because older people are more likely to have more than one health condition. In fact, 25% of Canadians over the age of 65 have at least three chronic health problems.

When prescribed and supervised properly, taking multiple medications can increase both the duration and quality of life for seniors. However, it also increases the risk of drug interactions, frailty, disability, cognitive difficulties, and hospitalizations. This has led to a move toward deprescribing, in which people are carefully weaned off medications they may no longer need. Pharmacists play a key role in assessing patients’ medications and working collaboratively with the primary care provider to ensure that any changes are in the patient’s best interest.

Faced with such a good news/bad news situation, residential care facilities have an important obligation to choose a pharmacy provider that is prepared to maximize the benefits and minimize any potential problems regarding patients’ overall healthcare. Sounds good, but just how do you do that? According to Chris Chiew, General Manager of Pharmacy for London Drugs, the first step is to select a pharmacy partner that is as committed to providing quality care as you are.

The pharmacy should be willing to assign clinical pharmacists to your facility who will:

• Provide on-site clinical services at an agreed upon schedule.
• Provide comprehensive enhanced medication reviews.
• Work collaboratively with facility staff to offer guidance and support when needed.
• Work with the medication safety and advisory committee to develop and implement medication safety initiatives.
• Provide education to facility staff and residents.
• Immunize facility staff, residents, volunteers, and their families.
• Assist in accreditation activities for the facility.
• Provide pharmacy indicator reports (e.g., antipsychotic use, narcotic use, polypharmacy).
• In some jurisdictions, pharmacists can prescribe medications and provide documentation for primary care providers to ensure a collaborative approach to obtaining optimal health outcomes.

In addition to regularly scheduled general medication reviews, your pharmacy partner should help prevent drug related problems. The pharmacist can pay particular attention to drugs that may cause special problems for the elderly and make recommendation for dosing based on kidney function. For example, certain classes of medications (e.g., antihistamines, antihypertensives, and diuretics) can cause dizziness and lead to falls and hospitalization. A pharmacist can alert the staff to monitor blood pressure and implement changes to minimize falls. In other instances, a pharmacist may be able to suggest an alternative to the medication prescribed that may lower the risk of developing a serious adverse event.

Choosing the right pharmacy partner is vital to ensuring the safety of your residents. It can also be important to your facility, as the relationship with the pharmacy and site staff is crucial to building a culture of trust and mutual respect.

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Chris Chiew’s Checklist for Selecting a Pharmacy Partner

Chris Chiew offers the following checklist you can use to assess the services your pharmacy partner should provide:

• Multiple regularly scheduled deliveries weekly plus emergency deliveries when necessary
• Medications dispensed in pouch packaging or card system
• Return and safe disposal of discontinued and expired medications
• Return and safe disposal of packaging with residents’ names
• Safe and accountable transportation of medications including narcotics
• 24/7, 365-day pharmacist consultation
• Electronic medication administration record
• Medication carts and pill crushers
• Individualized resident billing
• Special authority alerts and renewals
• Pre-approval for non-benefit medications
• Automatic sending of not-in-pass medications (e.g., eye drops, insulin, puffers) to prevent stockpiling or shortage of doses
• Specialized wound, incontinence, and ostomy supplies billed to residents directly
• Compression stocking measured to fit
• Availability of best practice protocols (e.g., actively dying, constipation management, hypoglycemia management, warfarin dosing, safe disposal of sharps)

Susan C. Jenkins is a freelance writer and editor specializing in medicine, pharmacy, and healthcare. She can be reached at susancjenkins@gmail.com