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Simple list improves community access to palliative medicines

Paul Tait, Advance Practice Pharmacist with Southern Adelaide Palliative Services.

Results from a project encouraging SA community pharmacists to stock five core palliative medicines were presented for the first time today at the 13th Australian Palliative Care Conference in Melbourne.

Paul Tait, Advance Practice Pharmacist with Southern Adelaide Palliative Services, said a state-wide list of injectable medications was developed in 2012 to try and improve access to medications for people who wished to die at home.

Surveys undertaken in 2012 and then again in 2015 showed pharmacists were now significantly more likely to stock the core injectable medications.

“The proportion of pharmacies carrying the five core medicines rose from 6.7% in 2012 to 18.4% in 2015,” Mr Tait said.

Expiry date data also showed a higher turnover of the medications, demonstrating that they were being prescribed more frequently.

Mr Tait said the project responded to the challenge pharmacists faced in deciding what medication to stock, given the small proportion of people within the community who required it.

“These medications have a normal shelf life of two to three years, so with such a small potential for turnover there was a risk of it expiring on the shelves.

“The pharmacies are businesses and they have to wear the cost. So it is a business decision versus a clinical decision.

“As a clinician, I would be saying we don’t want people being symptomatic, but pharmacists are not necessarily part of that discussion early on, so they are just seeing it as a request for medicine.

“They may not see it in terms of the pain someone’s father is in. They may not understand that without timely access to medication, carers may see a transfer to hospital as their only option.”

Mr Tait said it was possible to devise a list of five medications because palliative patients in the community typically had less complex conditions than those in hospice or acute settings. The list includes injectable clonazepam, haloperidol, hyoscine butylbromide, metoclopramide and morphine sulfate.

“It was felt that this defined list of medicines could sustainably be held in community pharmacies and that it would also guide prescribers,” he said.

Mr Tait said adopting the five core medicines nationally had potential to reduce the anxiety carers felt when there was any delay in controlling symptoms such as pain or delirium. This in turn, could reduce pressure on the hospital system.

“I know if it was my father and he had uncontrolled symptoms, I would be calling an ambulance,” he said.


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