DRAFT prepared 12.12.2018. Property of The Society of Hospital Pharmacists Australia 1

Standard of Practice in Geriatric Medicine for Pharmacy Services 1

Geriatric Medicine Standard Working Group* 2

3

Suggested citation: SHPA Geriatric Medicine Standard Working Group (2018). Standard of Practice in 4

Geriatric Medicine for Pharmacy Services. Standard of Practice series. The Society of Hospital 5

Pharmacists Australia (SHPA). 6

7

Preface 8

This Standard is for professional practice and is not prepared or endorsed by Standards Australia. It 9

is not legally binding. 10

This Standard references and relies upon the SHPA Standards of Practice for Clinical Services (1) as 11

the foremost Standard. This Standard may overlap with others and depending on the area of 12

specialty practice it may be advisable to refer to additional Standards of Practice. 13

The use of the word ‘specialisation’ in this standard is in line with the National Competency Standards 14

Framework for Pharmacists in Australia (2) where ‘specialisation’ refers to the scope of practice rather 15

than the level of performance. ‘Specialisation’ of itself does not confer additional expertise. 16

17

Introduction 18

Older People 19

In developed countries the term ‘older people’ usually refers to people aged 65 years and over. In 20

Australia this age is used to determine eligibility for some aged care services. However, 65 years is 21

an arbitrary cut-off and individual people age differently. For many people better healthcare and living 22

standards has delayed the onset of health and physical problems typically associated with ageing, so 23

they remain healthy and active into their 70s or 80s. On the other hand, some people develop 24

geriatric syndromes and frailty in their 50s. Indigenous Australians have a lower average life 25

expectancy than the general population and are eligible for aged care services from the age of 50 26

years. The term ‘older’ is preferred over ‘elderly’, ‘aged’ or ‘geriatric’ when describing a person over 27

65 years of age, as the latter terms carry negative connotations and may lead to generalisations 28

about the health and physical status of the older person. 29

30

Older people constitute a large and growing proportion of the population, making geriatric medicine 31

a rapidly growing specialty. Pharmacists who specialise in geriatric medicine pharmacy practice work 32

in a variety of settings. These include acute and subacute geriatric medicine units, other hospital 33

DRAFT prepared 12.12.2018. Property of The Society of Hospital Pharmacists Australia 2

units that focus on the care of older people (e.g. psychogeriatric and orthogeriatric units), residential 34

aged care facilities (RACF) and community-based programs (e.g. Transition Care, Hospital Outreach, 35

Home Care). The principles of geriatric medicine and geriatric pharmacy practice are also relevant in 36

other healthcare settings in which older people are managed, for example general medicine units, 37

oncology units and primary care. 38

A central component of geriatric medicine is ‘comprehensive geriatric assessment’ (CGA) (3). CGA 39

provides a comprehensive assessment of the older person’s health and wellbeing, with input into 40

the diagnosis and management plan from multiple disciplines (4). It includes assessment of medical, 41

cognitive, affective, functional and social issues, and development of a management plan that 42

considers the patient’s goals and preferences. Medication review and assessment of patients’ 43

medication management are important components of geriatric assessment, and core roles of the 44

geriatric pharmacist (3, 5). 45

There is a substantial body of published literature demonstrating the clinical and economic benefits 46

of clinical pharmacy services for older people in inpatient, residential care and ambulatory settings. 47

Clinical benefits include: prevention, identification and resolution of adverse drug reactions and 48

other medication-related problems, improved quality of prescribing, enhanced continuity of 49

medication management during care transitions and better medication adherence (5-20). In some 50

patient groups, pharmacist review may reduce unplanned hospitalisations (20). 51

Geriatric medicine pharmacists require specialised knowledge and expertise to contribute effectively 52

to the care of older people because medication management for older patients differs significantly 53

from that of younger adults (Table 1). Geriatric syndromes, many of which may be caused or 54

worsened by medicines or may impact on the older person’s ability to manage their medicines, 55

further complicate medication management. Syndromes that are common in older people include: 56

cognitive impairment (delirium and dementia), incontinence, immobility, falls, frailty, functional 57

impairment and iatrogenic disease. These often have multifactorial aetiologies (including medication 58

reactions) and have a major impact on older peoples’ quality of life. 59

Table 1 How medication management for older people differs from younger adults. 60

• Higher prevalence of multimorbidity and polypharmacy.

• Altered and variable pharmacokinetics and pharmacodynamics.

• Decreased physiological reserve and resilience.

• Increased susceptibility to drug interactions and ADRs.

• Atypical presentation of illness and ADRs.

DRAFT prepared 12.12.2018. Property of The Society of Hospital Pharmacists Australia 3

• Limited evidence with respect to effectiveness and safety of medications, especially in

multi-morbid and frail older people (due to their exclusion from most clinical trials).

• Variable goals of care, especially in frail individuals and those with limited remaining life

expectancy (e.g. maintaining function and quality of life and avoiding ADRs may be

prioritised over aggressive disease management and achievement of stringent treatment

targets).

• Higher prevalence of impaired functional capacity and cognitive decline, impacting on

patients’ ability to manage complex medication regimens.

• More complex care transitions as a result of polypharmacy, multiple medication changes,

use of pharmacy-packed dose administration aids (DAAs), and transfer to settings in which

medication charts or orders are needed to enable ongoing medication administration (e.g.

residential aged care, community nursing care).

ADR = adverse drug reaction 61

62

Objectives of the Service 63

The objective of a geriatric medicine pharmacy service is to provide patient-centred care to optimise 64

medication-related outcomes for older people. 65

The pharmacist should work with other members of the multidisciplinary team to ensure that drug 66

therapy for the older person is rational, safe, cost-effective and acceptable to the patient. They 67

should focus on preventing and detecting ADRs, including atypical ADRs such as those that present 68

as geriatric syndromes. When appropriate, the pharmacist should recommend and assist with 69

deprescribing to reduce unnecessary or inappropriate polypharmacy. They should assess patients’ 70

capacity to safely manage and adhere to their medication regimen, and implement strategies to 71

assist patients and carers with this task. Patient and carer education and ensuring continuity of 72

medication management during care transitions are core objectives. 73

74

Scope 75

These standards describe activities consistent with best practice for the provision of clinical 76

pharmacy services for older patients receiving geriatric care or aged care in any setting, including 77

hospitals, residential care facilities, transition care services and in the community. 78

DRAFT prepared 12.12.2018. Property of The Society of Hospital Pharmacists Australia 4

The scope of services provided by geriatric medicine pharmacists will be dependent on the setting, 79

funding models, the priorities of the organisation and the scope of practice of the individual 80

pharmacist. 81

As well as providing clinical pharmacy services for individual patients, the geriatric medicine 82

pharmacist should be a point of contact for geriatric medicine pharmacy related enquiries from 83

other pharmacists and health professionals within the health or aged care service. The role of the 84

pharmacist in geriatric medicine should also include involvement in development of policies, 85

procedures, guidelines and resources, comment on medicine formulary issues, provision of 86

educational programs and training for pharmacy students, intern pharmacists, postgraduate 87

pharmacists, pharmacy technicians and other healthcare professionals, as well as quality 88

improvement activities and research related to geriatric medication management. 89

90

Operation 91

Access to clinical pharmacy services 92

Older patients in all healthcare settings should have access to a clinical pharmacy service. 93

In hospital inpatient settings, best practice is to provide a comprehensive geriatric medicine 94

pharmacy service in accordance with these standards 7 days a week (1). If a geriatric medicine 95

pharmacy service is not available on weekends and public holidays, the pharmacy department 96

should provide a general clinical pharmacy service on those days to ensure that newly admitted 97

patients are reviewed and discharging patients are reviewed and receive discharge medication 98

counselling and clinical handover (1). 99

For residential and community aged care, a less intensive clinical pharmacy service would be 100

appropriate. 101

Identifying patients who require clinical pharmacist review 102

If a geriatric medicine pharmacy service cannot review all patients, it should target people at 103

greatest risk of adverse medication events. The broad criteria used to determine eligibility for 104

pharmacist services such as Home Medicines Reviews (21) do not effectively identify those at 105

greatest risk (22). The SHPA has developed criteria that may identify at-risk patients more effectively 106

(23). 107

Transitions between care settings and changes to an older person’s care needs are associated with 108

increased risk of adverse medication events and indicate the need for a clinical pharmacist review 109

(Table 2). 110

DRAFT prepared 12.12.2018. Property of The Society of Hospital Pharmacists Australia 5

Table 2 Examples of transitions that indicate need for clinical pharmacist review of an older person 111

• Admission to hospital

• Discharge from hospital

• Discharge from a Transition Care Program

• Admission to a residential aged care facility (RACF)

• Referral to an Aged Care Assessment Team (ACAT)

• Referral to a home nursing service for medication management

• Admission to a home care package (Australian Government-funded aged care at home)

• Admission to a palliative care service

112

Policies and Procedures 113

Geriatric medicine pharmacists must have knowledge of the following: 114

• Australian Charter of Healthcare Rights (24). 115

• Pharmacy Board of Australia Code of Conduct (25). 116

• National Competency Standards Framework for Pharmacists in Australia (2). 117

• Professional Practice Standards (26). 118

• Legislation, specifically State and Territory Acts and Regulations. 119

These documents provide a framework within which the pharmacist must practice. 120

Guidelines of relevance to geriatric medicine pharmacists are listed in Appendix 1. Resources. 121

Components of a geriatric medicine clinical pharmacy service 122

A summary of the components of a geriatric medicine pharmacy service in different practice settings 123

is provided in Table 3. 124

The range of services provided by a geriatric medicine pharmacist are generally similar to those 125

provided for other patient populations, however the focus or prioritisation of the service may differ. 126

This section of the standards does not describe all clinical pharmacy procedures that form a geriatric 127

medicine pharmacy service. Its purpose is to highlight key differences and procedures as they relate 128

to older patients. 129

Medication history and reconciliation 130

Medication reconciliation is especially important for older patients due to the high prevalence of 131

multimorbidity and polypharmacy, interaction with multiple health services and prescribers, and 132

factors that make history-taking more challenging, such as cognitive impairment and poor health 133

DRAFT prepared 12.12.2018. Property of The Society of Hospital Pharmacists Australia 6

literacy. Greater time and effort may be required to obtain the best possible medication history in 134

this population. 135

Medication reconciliation should be undertaken on every: 136

• presentation or admission to a health or aged care service (including hospitals, clinics, and 137

residential and community aged care services); 138

• transfer between wards and care settings within an organisation; 139

• transfer between community-based providers (1, 12, 27). 140

Medication reconciliation should also occur whenever handwritten medication charts are re-written 141

and when there are significant changes to a person’s medication regimen (e.g. following a 142

medication review, to ensure that intended medication changes are correctly implemented. 143

Medication review 144

Medication review, referred to as ‘assessment of current medication management’ in the Standard 145

of Practice for Clinical Pharmacy Services (1), is a vital component of health care for older people, 146

especially those who use multiple medications (27-31). 147

An interdisciplinary approach to medication review is recommended, involving the pharmacist, 148

medical practitioner(s) and aged care or community nurse (27, 29, 30). The patient’s views, concerns 149

and wishes should be central to the review. For patients who are unable to participate in the review, 150

for example due to severe cognitive impairment, their advance care plans should be considered, if 151

available, and their carer or substitute decision-maker (e.g. medical power of attorney) should be 152

involved. 153

For hospital inpatients, medication reviews should occur on admission, during the hospital stay and 154

prior to discharge (1, 32, 33). Medication review on admission should focus on identifying 155

medications and un-treated or under-treated medical problems that may have contributed to the 156

person’s presenting complaints. Subsequent medication reviews provide an opportunity to reassess 157

the benefits and risks of pre-admission medications, ensure appropriateness of new medications, 158

deprescribe unnecessary or inappropriate medications and simplify the discharge medication 159

regimen (34, 35). Medication review is also recommended for older surgical patients as part of pre-160

operative and post-operative assessments (36, 37). 161

In community and residential aged care settings it is recommended that a comprehensive, 162

interdisciplinary medication review occur at least once every 12 months (27, 28, 38). People moving 163

into a RACF should have a comprehensive medication review 4 to 6 weeks after admission. This 164

timing allows the person to adjust to their new environment, with potentially improved nutrition, 165

hydration and medication adherence. It is also an ideal time to reassess the benefits and risks of 166

DRAFT prepared 12.12.2018. Property of The Society of Hospital Pharmacists Australia 7

long-term medications and develop and implement a deprescribing plan if necessary. Additional 167

reviews should occur when there is a significant change to the patient’s health or medication 168

regimen, and within 5-10 days of discharge from hospital (27, 29, 30, 38). 169

Referral to an aged care assessment team (ACAT) or home nursing service should trigger a 170

medication review since these events indicate a decline in functional capacity which may be related 171

to medications or may impact on the older person’s ability to manage medications (16, 39). 172

173

Whenever possible, medication reviews (in all settings) should include face-to-face discussion 174

between the pharmacist and prescriber(s) to enable efficient and effective communication and 175

decision-making and ensure that potential medication-related problems are addressed. If a face-to-176

face discussion is not possible telehealth is an alternative. Professional practice guidelines and 177

standards for pharmacists relating to the medication review process are listed in Appendix 1. 178

ADR detection and management 179

Iatrogenic disease and prescribing cascades (where a medication is prescribed to manage the 180

adverse effects of another medication) are common in older patients. ADRs may be difficult to 181

detect as a result of atypical presentation (3). 182

ADR should be considered as a potential cause of any new symptom in an older person. Monitoring 183

for ADRs should occur when any new medication is commenced or a dose is increased. Monitoring 184

should also occur following any change to an older person’s medication management that may lead 185

to a sudden increase in medication adherence, such as admission to hospital or a RACF, assistance 186

with medication-taking (e.g. by a home nursing service) or implementation of a DAA. 187

It is also important to monitor for adverse drug withdrawal events when long-term medications are 188

stopped or deprescribed. Adverse drug withdrawal events include recurrence of the original 189

symptom, withdrawal symptoms, or rebound phenomenon (40). 190

Monitoring for ADRs and adverse drug withdrawal events is a shared responsibility involving the 191

prescriber, pharmacist, nurse, and the patient and their carer. 192

Deprescribing 193

Deprescribing attempts to balance the potential for benefit and harm by systematically withdrawing 194

unnecessary or inappropriate medications, with the goal of managing polypharmacy and improving 195

outcomes (40). Deprescribing has become a major focus of geriatric medicine and pharmacy 196

practice, and is especially important for older people with limited remaining life expectancy (41). 197

Since people in their last year of life present to hospital on average two to four times, admission to 198

hospital may be a trigger to discuss end of life care and consider deprescribing in people who are 199

DRAFT prepared 12.12.2018. Property of The Society of Hospital Pharmacists Australia 8

clearly declining in health (41). Deprescribing should also be considered following admission to a 200

RACF, where the average remaining life expectancy is around two years. 201

Other triggers to consider deprescribing include ADR, high treatment burden, or a decline in 202

functional capacity (which may be indicated by referral to an ACAT, home nursing service or home 203

care package). 204

The rationale for deprescribing decisions should be documented in the patient’s medical record and 205

communicated in clinical handover, including criteria for reintroduction of the medication (40). A 206

plan for follow-up of outcomes is also important. These steps reduce the risk of ADWEs, and allows 207

for the prompt re-introduction of the medication if indicated. 208

Deprescribing decisions should occur as part of a comprehensive medication review and in 209

consultation with the patient and/or their carer or substitute decision-maker. Protocols, algorithms 210

and guidelines for deprescribing are available (42). 211

Regimen simplification 212

Simplification of medication regimens can improve adherence and reduce treatment burden for 213

patients and carers. Simplification may involve medication withdrawal or changes to dose-forms, 214

dose-times and dose-frequencies (34). Regimen simplification should form part of all comprehensive 215

medication reviews for older people. The impact on regimen complexity should also be considered 216

at the time of prescribing, reviewing or dispensing a new medication, because sometimes an 217

alternative medication, dose-form or dose-regimen may be available that will have less impact on 218

the complexity of the patient’s medication regimen. 219

Assessment of patient’s ability to manage medicines 220

Older patients are more likely to have barriers to accurate and safe medication management than 221

younger patients. Barriers include: polypharmacy, cognitive or sensory impairment, reduced manual 222

dexterity and poor health literacy. Assessment of a patient’s (or carer’s) ability to manage and 223

adhere to their medication regimen helps to determine whether a patient needs assistance or 224

medication aids such as medication reminders or a dose administration aid (DAA). 225

Examples of situations where an assessment of a patent’s ability to manage medicines should be 226

considered include: when there has been a change in the patients’ functional capacity (e.g. following 227

an acute event such as stroke or delirium), when there are changes to the patient’s medication 228

regimen (especially changes that increase regimen complexity or introduce new dose-forms), or 229

when there are concerns about the patient’s capacity to safely manage their medicines. In 230

residential care, when a resident wants to self-administer medicines an assessment of their capacity 231

must be conducted (27, 30). 232

DRAFT prepared 12.12.2018. Property of The Society of Hospital Pharmacists Australia 9

Various performance-based instruments exist to assess a patient’s capacity to manage their 233

medications (43, 44). Content of tools is variable, but most include ability to read and explain a 234

dispensing label, open packaging and remove a dose, orientation to time and memory recall (43). 235

Some tools use the patient’s own medication for the assessment, whereas other use a mock 236

medication regimen. The former may be best suited to settings in which the patient’s own 237

medications are available, such as in the patent’s home. The latter may be more feasible in the 238

hospital setting (44). Supervised self-administration of medicines (see next section) can also be used 239

to assess a patients’ ability to manage medicines. 240

An assessment of medication management ability should be performed before implementing a DAA 241

such as a Dosett box, blister pack (e.g. Webster Pak) or sachet system (18). DAAs are not suitable for 242

all patients (6, 18). Sometimes simpler, less costly alternatives may be suitable, such as regimen 243

simplification and use of reminder charts or alarms. Approaches to assessing patients’ suitability for 244

DAAs have been published (6, 18). 245

Self-administration of medicines programs (SAMP) 246

Self-administration of medicines programs (SAMP) are used mainly in sub-acute hospital units and 247

residential care facilities to assess patients’ ability to safely manage their medications, encourage 248

patient participation in their care, provide education and training in medication-taking and identify 249

supports required for ongoing medication management (45, 46). Patients who complete a SAMP 250

may demonstrate better drug knowledge, better adherence and fewer medication errors (47). 251

In hospitals, a SAMP should be considered for patients who plan to self-administer their medicines 252

after discharge and have had significant changes to their medication regimen and/or changes in their 253

functional capacity. In residential care, a SAMP should be conducted when a resident wants to self-254

administer their medicines. SAMP could also be considered in other settings such as people living at 255

home with an aged care package or community nursing support. 256

A SAMP commences with an assessment to determine suitability of the patient for the program, 257

format of medicine supply and to obtain patient consent. Medicines are dispensed with full 258

directions, in the format that the patient will use (original packs or DAA). The patient then 259

administers their medicines with direct nurse supervision. If the patient demonstrates correct 260

administration over several days the program may allow for greater patient independence with 261

regular monitoring. 262

Patients suitable for SAMP are medically stable with a consistent medication profile. Geriatric 263

medicine pharmacists are involved in identifying suitable patients, patient assessment, organising 264

the supply of medicines in the required format, providing education and monitoring outcomes. 265

DRAFT prepared 12.12.2018. Property of The Society of Hospital Pharmacists Australia 10

Facilitating continuity of medication management on transition between care settings 266

Geriatric medicine pharmacists should provide medicines information to patients, carers and health 267

professionals during transitions of care, ensure ongoing access to medicines, and ensure that 268

medications are able to be safely and accurately administered after a transition of care (1, 32). 269

All older patients who use multiple medicines should be provided with a patient-held medication list 270

(in addition to verbal instructions) (29, 48). At transitions of care the medication list should also 271

include information about medicines that have been recently discontinued. As noted above, 272

patients’ ability to manage their medicines should be assessed, and appropriate medication 273

management strategies and supports implemented. 274

If RACF staff or community nurses will be supporting the patient, they usually require medication 275

administration orders. It is recommended that hospitals provide an interim medication 276

administration chart for all patients discharged to RACFs to avoid medication administration delays 277

and errors upon arrival at the RACF (30). These can be prepared by a pharmacist or hospital medical 278

officer (30). A copy of the interim chart should be provided to the patient’s community pharmacy. 279

When a community pharmacy-packed DAA is used upon discharge from hospital, the packing 280

pharmacy must be provided with information to enable timely and accurate DAA preparation. 281

Provision of discharge medication information to community pharmacists is also important for non-282

DAA users who have had significant changes to their medication regimen in hospital. 283

Patient and carer education 284

Medication information and education should be provided to all older patients, including those using 285

a DAA and patients living in residential care facilities, even if they are not self-administering their 286

medicines. It should include both verbal and written information. For some patients with cognitive 287

impairment or poor literacy, Consumer Medicines Information may be too complex and simpler 288

written materials should be offered. Pharmacists should ensure language used is simple and clear 289

and avoids unnecessary medical terminology. Physical impairments including visual and auditory 290

changes may impair an older person’s ability to receive the message being delivered. Use of 291

appropriate light, colour, font and a lower pitch voice and checking for hearing aids are important 292

when delivering medication information. Speaking slowly, breaking downs tasks and demonstration 293

is necessary in those with cognitive impairment (49). For patients on multiple medications a 294

medication list should be provided, and the patient should be encouraged to keep this up to date. 295

It is recommended that education for inpatients is provided throughout the admission, because 296

delivering a large volume of information at the point of discharge may be overwhelming and 297

ineffective. 298

DRAFT prepared 12.12.2018. Property of The Society of Hospital Pharmacists Australia 11

Older persons may have third parties managing their medicines (e.g. carer or nurse). Whilst these 299

parties may require medication education, it is important to still involve the patient unless they are 300

unable or have indicated that they do not want to receive education. 301

Interdisciplinary teamwork 302

Interdisciplinary teamwork is at the core of evidence-based models of geriatric medicine. 303

Participation in interdisciplinary activities is an effective avenue for pharmacists to build rapport 304

with other clinicians (e.g. medical practitioners, nurses and allied health including occupational 305

therapists, speech pathologists and dieticians) and contribute to patient care. 306

Geriatric medicine pharmacists should routinely participate in interdisciplinary ward rounds and 307

other forums at which decisions about medication management are made, such as team meetings 308

and case conferences. The geriatric medicine pharmacist’s contributions to team discussions should 309

include providing information about current and recent medication use and medication changes, 310

ADR identification, advice about appropriate medication selection, deprescribing and discharge 311

planning. 312

Geriatric medicine pharmacists must be proactive participants in discussions about hospital 313

discharge planning, to ensure that medication management issues are considered and addressed 314

before decisions are made about the discharge destination and support services. 315

Quality use of medicines activities 316

Geriatric medicine pharmacists should lead or contribute to quality use of medicines (QUM) 317

activities, to optimise medication management and patients’ health outcomes in all health and aged 318

care settings. 319

QUM activities can take many forms including (21): 320

• educational activities for health professionals, carers and patients/residents; 321

• continuous quality improvement activities such drug use evaluations; 322

• participation in Medication Advisory Committees; 323

• development of medicine-related policies and procedures; 324

• assisting the organisation to meet and maintain medication management accreditation 325

standards. 326

Recommended Staffing 327

The level of geriatric medicine pharmacy service should be agreed with the health or aged care 328

service provider and the healthcare team, and resourced appropriately to enable delivery of the 329

agreed service. The ideal geriatric medicine clinical pharmacy service and associated pharmacist 330

DRAFT prepared 12.12.2018. Property of The Society of Hospital Pharmacists Australia 12

staffing ratios for different aged care settings are described in Table 3. These recommendations are 331

based on published evidence (50, 51) consensus guidelines (1, 27-30, 32, 52, 53), and consultation 332

experienced geriatric medicine pharmacists and geriatricians. They assume the pharmacist will be 333

primarily providing clinical services and will have limited or no direct involvement in medication 334

supply functions. 335

Many factors influence the ability of geriatric medicine pharmacists to deliver the clinical services 336

recommended in these standards, such as funding, staffing levels, extent of integration of 337

pharmacists into the multidisciplinary team, education and training of the pharmacist and availability 338

of support staff (e.g. pharmacy technicians, dispensary pharmacists, quality use of medicines 339

pharmacists). In residential and community aged care settings, the size of the service, travel 340

distances required to provide the service and the number and location of medical practitioners will 341

impact on efficiency of the clinical pharmacy service and staffing levels required. 342

Where possible, pharmacy technicians should be employed to support the geriatric medicine clinical 343

pharmacist, because this has been shown to increase the number of patients able to be reviewed by 344

the pharmacist and improve timeliness of review (51). Tasks that can be undertaken by pharmacy 345

technicians are described elsewhere (1).346

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Table 3 Recommended clinical pharmacy services and pharmacist:bed ratios for aged care services 347

Type of care

Acute aged care* Subacute inpatient aged

care

Residential aged care Community aged care^

Average LOS 7-10 days 14-28 days 24 months (8 weeks for

residential Transition Care

Program [TCP] clients)

Variable

Optimal pharmacist:bed ratio 1:20 1:30 1:200 (1:40 for residential

TCP)&&

See footnote%

Optimal clinical pharmacy service

• Medication history and

reconciliation on admission

Yes, within 24 hours Yes, within 24 Yes, within 72 hours** Yes, within 72 hours**

• Medication chart review and

clinical review

Yes, daily Yes, at least 2nd-daily Yes, at least monthly. Yes, at least monthly

• Reconciliation of new dose

administration aid (DAA) packs

with medication orders/charts

when packs are supplied.

DAAs not routinely used

in acute aged care

Yes, if patient is

participating in a self-

administration of

medications program using

DAAs

Yes$ Yes$

DRAFT prepared 12.12.2018. Property of The Society of Hospital Pharmacists Australia 14

Type of care

Acute aged care* Subacute inpatient aged

care

Residential aged care Community aged care^

• Comprehensive interdisciplinary

medication review

Yes, within 3 days of

admission

Yes, within 7 days of

admission

Yes, within 4-6 weeks of

admission and repeated at

intervals determined by

clinical need (not less than

yearly, and within 5-10

days of returning from an

unplanned hospital

admission)

Yes, within 4-6 weeks of

admission and repeated at

intervals determined by

clinical need (not less than

yearly, and within 5-10

days of returning from an

unplanned hospital

admission)

• Monitoring and review of

deprescribing plan and

outcomes, following a

comprehensive medication

review.

Yes, at least weekly (with

plan for ongoing

monitoring provided in

discharge summary)

Yes, at least weekly (with

plan for ongoing

monitoring provided in

discharge summary)

Yes, at least 4 weekly Yes, at least 4 weekly

• Multidisciplinary ward round

participation

Yes, at least twice-weekly Yes, at least once-weekly Yes (if available) Yes (if available)

DRAFT prepared 12.12.2018. Property of The Society of Hospital Pharmacists Australia 15

Type of care

Acute aged care* Subacute inpatient aged

care

Residential aged care Community aged care^

• Multidisciplinary team meeting /

case conference participation

Yes, weekly Yes, weekly Yes (if available) Yes (if available)

• Provision of information and

advice to prescribers, nurses and

carers

Yes Yes Yes Yes

• Provision of information to

patients and/or carers about

medication changes

Yes Yes Yes$ Yes$

• Assessment of patients’ ability to

self-administer medications

Yes, if discharge plan is for

patient to manage own

medicines

Yes, if discharge plan is for

patient to manage own

medicines

Yes, if patient wishes to

self-administer medicines

Yes, if patient wishes to

self-administer medicines.

• Self-administration of medicines

program^^

Not routinely used in

acute aged care

Yes, if plan is to manage

own medicines after

discharge

Yes, if patient wishes to

self-administer medicines

Yes, if patient wishes to

self-administer medicines

• Development of a plan for

medication management after

discharge

Yes Yes Yes (residential TCP) Yes

DRAFT prepared 12.12.2018. Property of The Society of Hospital Pharmacists Australia 16

Type of care

Acute aged care* Subacute inpatient aged

care

Residential aged care Community aged care^

• Discharge prescription review

and reconciliation

Yes Yes Yes NA

• Preparation and delivery of

discharge medication

information for patient/carer#

Yes Yes Yes NA

• Preparation and delivery of

medication information for

clinical handover (to

community pharmacy, GP,

community nurse, RACF and/or

hospital as applicable)@

Yes Yes Yes Yes

• Referral to post-discharge

medication review service if

patient meets eligibility and risk

criteria&

Yes Yes Yes Yes

• Medication reconciliation after

any care transition (e.g. transfer

Yes Yes Yes$ Yes$

DRAFT prepared 12.12.2018. Property of The Society of Hospital Pharmacists Australia 17

Type of care

Acute aged care* Subacute inpatient aged

care

Residential aged care Community aged care^

between units, after hospital

discharge)

• Participation in medication

management committees

Yes Yes Yes Yes

• Quality Use of Medicines

activities (e.g. audits, staff

education)

Yes Yes Yes Yes

• Contributing to Medication

policy and procedure

development

Yes Yes Yes Yes

* Acute aged care: Acute medical units for the aged and other acute units with a focus on older people (e.g. orthogeriatric units) 348

^ Community aged care: Formal care provided to the older person in their own home, such as Home Care Packages, community-based Transition Care Programme and 349

home nursing services. 350

&& Pharmacist to bed ratio in RACFs assumes the clinical pharmacist is not involved in reconciliation of new DAA packs with RACF medication administration charts or 351

provision of counselling/education to the patient or substitute decision-maker each time a new medication is dispensed (because these services are the responsibility of 352

the dispensing pharmacy service). If these roles are included, increased pharmacist resource would be needed. The pharmacist resource required will also be affected by 353

the size of the facility, number of medical practitioners, and the model of care (e.g. fewer medical practitioners who attend regularly for ‘ward rounds’ would increase 354

efficiency of the clinical pharmacy service) 355

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% The ratio of pharmacists to patients is variable as a result of variable length of stay within community aged care services and variable travel distances (e.g. metropolitan 356

versus rural). On average, a community-based clinical pharmacist can perform a comprehensive medication review for 2 to 3 patients/day depending on patient complexity 357

and travel distance 358

** If possible, the medication history should be obtained prior to admission (at the patient’s home) as this results in a more accurate history and will reduce the risk of 359

medication charting errors on admission. Reconciliation of the medication chart with the medication history should then occur as soon as possible after admission. 360

$ May be provided by the supplying pharmacy 361

^^ It is usually not feasible for all patients to participate in self-administration of medications program. Patients at highest risk of medication errors should be identified and 362

targeted. 363

# Verbal information, patient medication list (including all current medicines and medicines ceased in hospital) and consumer medicines information if applicable 364

@ Includes contributing medication information to the medical discharge summary, communicating medication changes to the patient’s community pharmacy and/or 365

preparation of an interim residential care medication administration chart. 366

& For example, hospital outreach medication review, HMR or RMMR service, to review medication management and outcomes of medication changes in consultation with 367

GP within 5-10 days of discharge 368

369

DRAFT prepared 12.12.2018. Property of The Society of Hospital Pharmacists Australia 19

Training and Education (for the service, and of the individual) 370

Training for geriatric medicine pharmacists should be provided by the organisation to improve the 371

pharmacists’ ability to care for older people, and pharmacists should also seek relevant external 372

professional development opportunities. 373

Education, training and professional development can be sourced from professional bodies such as: 374

• SHPA 375

• American Society of Consultant Pharmacy 376

• American Society of Health-System Pharmacists 377

• Universities, e.g. Monash University Geriatric pharmacy practice and Geriatric disease state 378

management postgraduate units 379

Educational material and resource and links to professional development opportunities are provided 380

on the SHPA Specialty Practice Geriatric Medicine stream page on the SHPA eCPD website. For 381

geriatric medicine pharmacists, joining and actively participating in the Geriatric Medicine Stream at 382

the Practice Group level is strongly recommended. 383

Attendance at specialist conferences and educational meetings is encouraged to maintain and 384

update specialist knowledge in geriatric medicine. Relevant domestic conferences include those 385

organised by SHPA, The Australian and New Zealand Society for Geriatric Medicine and The 386

Australasian Association of Gerontology. International conferences in geriatric medicine include 387

those organised by the International Association of Gerontology and Geriatrics, the British Geriatrics 388

Society and the American Geriatrics Society. 389

Credentialing 390

Pharmacists can obtain credentialing in geriatric medicine pharmacy practice by passing the Board of 391

Pharmacy Specialities Geriatric Pharmacy examination. This credential also enables pharmacists to 392

gain accreditation by the SHPA as a provider of Home Medicines Reviews (HMR) and Residential 393

Medication Management Reviews (RMMR). The Australian Association of Consultant Pharmacy 394

(AACP) can also accredit pharmacists to provide HMRs and RMMRs. 395

396

Quality Improvement 397

In addition to quality measures outlined in Chapter 14 of the SHPA Standards of Practice for Clinical 398

Pharmacy Services (1), a geriatric medicine pharmacy quality improvement program should 399

demonstrate that the service is targeting and delivering high quality care for patient groups at 400

DRAFT prepared 12.12.2018. Property of The Society of Hospital Pharmacists Australia 20

greatest risk for medicine misadventure. The geriatric medicine pharmacist should ensure that the 401

focus is not only on the timeliness of care, but also on the quality of care in line with national or 402

state based indicators. Many of the indicators under discussion nationally and internationally have a 403

medication-related element. 404

Indicators relevant to geriatric medicine pharmacy services include: 405

Australian National QUM indicators e.g. 406

• 3.1 Percentage of patients whose current medicines are documented and reconciled at 407

admission 408

• 5.5 Percentage of patients with a new adverse drug reaction (ADR) that are given written 409

ADR information at discharge AND a copy is communicated to the primary care clinician 410

• 5.9 Percentage of patients who receive a current, accurate and comprehensive medication 411

list at the time of hospital discharge 412

• 6.2 Percentage of patients that are reviewed by a clinical pharmacist within one day of 413

admission (to hospital) 414

ACOVE 3 quality indicators (Assessing the care of vulnerable elders, RAND Corp, USA) e.g. 415

• ALL vulnerable elders should have an annual drug regimen review 416

• IF a vulnerable elder is prescribed a drug, THEN the prescribed drug should have a clearly 417

defined indication 418

• IF a vulnerable elder is prescribed an ongoing medication for a chronic medical condition, 419

THEN there should be documentation of response to therapy 420

Standard 14 (Medication Review) of the Pharmaceutical Society of Australia’s Professional Practice 421

Standards may be used to assess the quality of pharmacist medication review services.(26) 422

There are also numerous sets of indicators of appropriate prescribing for older people that could 423

potentially be used as a measure of the quality of care provided to geriatric medicine patients 424

(Appendix 1). 425

426

Research 427

Further information on research can be found in Chapter 11 of the SHPA Standards of Practice for 428

Clinical Pharmacy Services (1). 429

Geriatric pharmacists should contribute to the generation of new knowledge and evidence related to 430

medication management for older people. This may include investigating problems with medication 431

DRAFT prepared 12.12.2018. Property of The Society of Hospital Pharmacists Australia 21

use and evidence-practice gaps, developing and testing new approaches to improve medication use 432

or delivery of pharmacy services, and evaluating novel treatments. Research Ethics Committee 433

approval should be sought where applicable. It is advisable to establish an interdisciplinary research 434

team, including consumer representation, to ensure the research is relevant to key stakeholders. 435

Where applicable, core outcome sets for trials aimed at improving medication use in older people 436

should be used (54-57). 437

Presentation and publication of research is important to support the development of geriatric 438

medicine pharmacy practice and drive improvements in medication use and safety. Studies should 439

be designed and conducted with this in mind, to ensure the findings are publishable. 440

External funding enables larger and more complex studies to be conducted. The SHPA National 441

Translational Research Collaborative (NTRC) funds research grants, practitioner grants and 442

educational grants. Grants may also be available from other organisations such as the Australian 443

Association of Gerontology and various charitable trusts with an interest in aged care. 444

Acknowledgements 445

This Standard of Practice has been produced with expert consensus from the Geriatric Medicine 446

Practice Standards Working Group: Rohan Elliott (Chair), Alex (Ho Yin) Chan, Gauri Godbole, Ivanka 447

Hendrix, Lisa Pont, Dana Sfetcopoulos, John Woodward, with support from Courtney Munro, Lead 448

Pharmacist Specialty Practice, SHPA. 449

The SHPA additionally wish to acknowledge the substantive work of Rohan Elliott, Mary Etty-Leal 450

and John Woodward of the former SHPA Committee of Specialty Practice in Geriatric Medicine on a 451

previous draft of this Standard. 452

453

References 454

1. SHPA Committee of Specialty Practice in Clinical Pharmacy. SHPA Standards of Practice for 455 Clinical Pharmacy Services. Journal of Pharmacy Practice and Research. 2013;43(No. 2 456 Supplement):S1-69. 457

2. Pharmaceutical Society of Australia. National Competency Standards Framework for 458 Pharmacists in Australia. Deakin West ACT 26002016 2016. 459

3. Elliott RA. Geriatric medicine and pharmacy practice: a historical perspective. Journal of 460 Pharmacy Practice and Research. 2016;46(2):169-77. 461

4. Gladman JRF, Conroy SP, Ranhoff AH, Gordon AL. New horizons in the implementation and 462 research of comprehensive geriatric assessment: knowing, doing and the 'know-do' gap. Age 463 Ageing. 2016;45(2):194-200. 464

5. Schmader KE, Hanlon JT, Pieper CF, Sloane R, Ruby CM, Twersky J, et al. Effects of geriatric 465 evaluation and management on adverse drug reactions and suboptimal prescribing in the frail 466 elderly. Am J Med. 2004;116(6):394-401. 467

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6. Elliott RA. Appropriate use of dose administration aids. Australian Prescriber. 2014;37(2):46-468 50. 469

7. Gillespie U, Alassaad A, Henrohn D, Garmo H, Hammarlund-Udenaes M, Toss H, et al. A 470 comprehensive pharmacist intervention to reduce morbidity in patients 80 years or older: a 471 randomized controlled trial. Arch Intern Med. 2009;169(9):894-900. 472

8. Crotty M. Does the Addition of a Pharmacist Transition Coordinator Improve Evidence-Based 473 Medication Management and Health Outcomes in Older Adults Moving from the Hospital to a 474 LongTenn Care Facility? Results of a Randomized, Controlled Trial. The American Journal of 475 Geriatric Pharmacotherapy. 2004;2(4):257. 476

9. Deliens C, Deliens G, Filleul O, Pepersack T, Awada A, Piccart M, et al. Drugs prescribed for 477 patients hospitalized in a geriatric oncology unit: Potentially inappropriate medications and 478 impact of a clinical pharmacist. J Geriatr Oncol. 2016;7(6):463-70. 479

10. Spinewine A, Swine C, Dhillon S, Lambert P, Nachega JB, Wilmotte L, et al. Effect of a 480 collaborative approach on the quality of prescribing for geriatric inpatients: a randomized, 481 controlled trial. J Am Geriatr Soc. 2007;55(5):658-65. 482

11. Zermansky A, Petty DR, Raynor DK, Freemantle N, Vail A, CJ. L. Randomised controlled trial of 483 clinical medication review by a pharmacist of elderly patients receiving repeat prescriptions in 484 general practice. British Medical Journal. 2001;323(7325):1340-3. 485

12. Hanlon JT, Weinberger M, Samsa GP, Schmader KE, Uttech KM, Lewis IK, et al. A Randomized, 486 Controlled Trial of a Clinical Pharmacist Intervention to Improve Inappropriate Prescribing in 487 Elderly Outpatients With Polypharamcy. The American Journal of Medicine. 1996;100:428-38. 488

13. Lipton HL, Bird JA. The Impact of Clinical Pharmacists' Consultations on Geriatric Patients' 489 Compliance and Medical Care Use: A Randomized Controlled Trial. The Gerontologist. 490 1994;34(3):307-15. 491

14. Roberts M. Outcomes of a randomized controlled trial of a clinical pharmacy intervention in 492 52 nursing homes. Br J Clin Pharmacol. 2000;51:257-65. 493

15. Crotty M, Halbert J, Rowett D, Giles L, Birks R, Williams H, et al. An outreach geriatric 494 medication advisory service in residential aged care: a randomised controlled trial of case 495 conferencing. Age Ageing. 2004;33(6):612-7. 496

16. Elliott RA, Martinac G, Campbell S, Thorn J, Woodward MC. Pharmacist-led medication review 497 to identify medication-related problems in older people referred to an Aged Care Assessment 498 Team: a randomized comparative study. Drugs Aging. 2012;29(7):593-605. 499

17. O'Sullivan D, O'Mahony D, O'Connor MN, Gallagher P, Gallagher J, Cullinan S, et al. Prevention 500 of Adverse Drug Reactions in Hospitalised Older Patients Using a Software-Supported 501 Structured Pharmacist Intervention: A Cluster Randomised Controlled Trial. Drugs Aging. 502 2016;33(1):63-73. 503

18. Etty-Leal MG. The role of dose administration aids in medication management for older 504 people. Journal of Pharmacy Practice and Research. 2017;47(3):241-7. 505

19. Elliott RA, Tran T, Taylor SE, Harvey PA, Belfrage MK, Jennings RJ, et al. Impact of a pharmacist-506 prepared interim residential care medication administration chart on gaps in continuity of 507 medication management after discharge from hospital to residential care: a prospective pre- 508 and post-intervention study (MedGap Study). BMJ Open. 2012;2(3):8. 509

20. Jokanovic N, Tan EC, van den Bosch D, Kirkpatrick CM, Dooley MJ, Bell JS. Clinical medication 510 review in Australia: A systematic review. Res Social Adm Pharm. 2016;12(3):384-418. 511

21. Pharmaceutical Society of Australia. Guidelines for pharmacists providing Residential 512 Medication Management Review (RMMR) and Quality Use of Medicines (QUM) services. 513 Pharmaceutical Society of Australia Ltd.; 2011. 514

22. Elliott RA, Lee CY. Poor uptake of interdisciplinary medicine reviews for older people is a 515 barrier to deprescribing. BMJ. 2016;353:i3496. 516

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23. The Society of Hospital Pharmacists Australia (SHPA). SHPA Fact Sheet: Risk factors for 517 medication-related problems Fact sheets & position statements: SHPA; 2015 [Available from: 518 https://www.shpa.org.au/fact-sheets-position-statements. 519

24. Australian Charter of Healthcare Rights [press release]. 2008. 520 25. Pharmacy Board of Australia. For Pharmacists Code of Conduct. March 2014 ed2014. 521 26. Pharmaceutical Society of Australia. Professional Practice Standards Version 5. Deakin West 522

ACT 2600.2017. p. 116. 523 27. National Institute for Health and Care Excellence (NICE). Managing medicines in care homes. 524

2015. 525 28. Shrank WH, Polinski JM, Avorn J. Quality indicators for medication use in vulnerable elders. J 526

Am Geriatr Soc. 2007;55 Suppl 2:S373-82. 527 29. Australian Pharmaceutical Advisory Council. Guiding principles for medication management in 528

the community. Canberra: Commonwealth of Australia; 2006. 529 30. Department of Health and Ageing. Guiding principles for medication management in 530

residential aged care facilities. Canberra: Commonwealth of Australia; 2012. 531 31. Hilmer SN, editor Outcome Statement: National Stakeholders’ Meeting on Quality Use of 532

Medicines to Optimise Ageing in Older Australians. National Stakeholders’ Meeting: Quality 533 Use of Medicines to Optimise Ageing in Older Australians; 2015 03/08/2015. 534

32. Australian Pharmaceutical Advisory Council. Guiding principles to achieve continuity in 535 medication management. Canberra: Commonwealth of Australia; 2005. 536

33. Australian Commission on Safety and Quality in Health Care, NSW Therapeutic Advisory Group 537 Inc. National Quality Use of Medicines Indicators for Australian Hospitals. Sydney; 2014. 538

34. Elliott RA. Reducing medication regimen complexity for older patients prior to discharge from 539 hospital: feasibility and barriers. J Clin Pharm Ther. 2012;37(6):637-42. 540

35. McKean M, Pillans P, Scott IA. A medication review and deprescribing method for hospitalised 541 older patients receiving multiple medications. Intern Med J. 2016;46(1):35-42. 542

36. American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP), 543 American Geriatrics Society (AGS). ACS NSQIP® /AGS BEST PRACTICE GUIDELINES: Optimal 544 Preoperative Assessment of the Geriatric Surgical Patient. 2012. 545

37. American College of Surgeons National Surgical Quality Improvement Program (NSQIP), 546 American Geriatrics Society (AGS). Optimal Preoperative Assessment of the Geriatric Surgical 547 Patient.Best Practices Guideline from ACS NSQIP® /American Geriatrics Society. 2016. 548

38. Royal Pharmaceutical Society (RPS). The Right Medicine: Improving Care in Care Homes. 2016. 549 39. Elliott RA, Lee CY, Beanland C, Vakil K, Goeman D. Medicines Management, Medication Errors 550

and Adverse Medication Events in Older People Referred to a Community Nursing Service: A 551 Retrospective Observational Study. Drugs Real World Outcomes. 2016;3(1):13-24. 552

40. Page AT, Potter K, Clifford R, Etherton-Beer C. Deprescribing in older people. Maturitas. 553 2016;91:115-34. 554

41. Hardy JE, Hilmer SN. Deprescribing in the Last Year of Life. Journal of Pharmacy Practice and 555 Research. 2015;41(2):146-51. 556

42. Page AT, Potter K, Clifford R, Etherton-Beer C. Deprescribing in older people. Maturitas. 557 2016;91:115-34. 558

43. Elliott RA, Marriott JL. Review of Instruments used in Clinical Practice to Assess Patients’ 559 Ability to Manage Medications. Journal of Pharmacy Practice and Research. 2010;40(1):36-41. 560

44. Elliott RA, Marriott JL. Standardised assessment of patients' capacity to manage medications: 561 a systematic review of published instruments. BMC Geriatr. 2009;9:27. 562

45. Tran T, Elliott RA, Taylor SE, Woodward MC. A Self-Administration of Medications Program to 563 Identify and Address Potential Barriers to Adherence in Elderly Patients. The Annals of 564 pharmacotherapy. 2011;45(2):201-6. 565

46. SHPA Committee of Specialty Practice in Rehabilitation and Aged Care. SHPA Guidelines for 566 Self-Administration of Medication in Hospitals and Residential Care Facilities. 2002;32(4). 567

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47. Richardson SJ, Brooks HL, Bramley G, Coleman JJ. Evaluating the effectiveness of self-568 administration of medication (SAM) schemes in the hospital setting: a systematic review of 569 the literature. PLoS One. 2014;9(12):e113912. 570

48. Pharmaceutical Society of Australia. Guidelines and standards for pharmacists Medication 571 Profiling Service. Pharmaceutical Society of Australia; 2007. 572

49. Cappuzzo KA. Communicating with Seniors and Their Caregivers. The Consultant Pharmacist. 573 2008;23(9):695-709. 574

50. Elliott R, Perera D, Woodward M, Garrett K, Szysz A, Marriott J. Improving medication safety 575 for subacute aged care patients through innovative, expanded pharmacy assistant (technician) 576 support for clinical pharmacy services. Final report for the Workforce Innovation and Reform: 577 Caring or Older People Program.: Health Workforce Australia; 2011. 578

51. Elliott RA, Perera D, Mouchaileh N, Antoni R, Woodward M, Tran T, et al. Impact of an 579 expanded ward pharmacy technician role on service-delivery and workforce outcomes in a 580 subacute aged care service. Journal of Pharmacy Practice and Research. 2014;44(3):95-104. 581

52. National Institute for Health and Care Excellence (NICE). Medicines management in care 582 homes. 2015. 583

53. Position Statement No. 15 Discharge Planning 2008 [press release]. 2008. 584 54. Beuscart JB, Dalleur O, Boland B, Thevelin S, Knol W, Cullinan S, et al. Development of a core 585

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55. Beuscart JB, Pont LG, Thevelin S, Boland B, Dalleur O, Rutjes AWS, et al. A systematic review of 588 the outcomes reported in trials of medication review in older patients: the need for a core 589 outcome set. Br J Clin Pharmacol. 2017;83(5):942-52. 590

56. Millar AN, Daffu-O'Reilly A, Hughes CM, Alldred DP, Barton G, Bond CM, et al. Development of 591 a core outcome set for effectiveness trials aimed at optimising prescribing in older adults in 592 care homes. Trials. 2017;18(1):175. 593

57. Rankin A, Cadogan CA, In Ryan C, Clyne B, Smith SM, Hughes CM. Core Outcome Set for Trials 594 Aimed at Improving the Appropriateness of Polypharmacy in Older People in Primary Care. J 595 Am Geriatr Soc. 2018;66(6):1206-12. 596

597

598

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Appendices

Appendix 1. Resources for geriatric medicine pharmacy practice

Recommended texts

• Australian Medicines Handbook Aged Care Companion

Discretionary texts

• ABC of Geriatric Medicine. Cooper N, Mulley G, Forrest K, eds. BMJ Books, Blackwell

Publishing Ltd 2009 (basic introductory text)

• Essentials of clinical geriatrics. 7th ed. Kane RL, Ouslander JG, Abrass IB, Resnick B. McGraw-

Hill, 2013 (intermediate text)

• Current diagnosis and treatment: geriatrics. 2nd ed. Williams BA, Chang A, Ahalt C, et al, eds.

McGraw-Hill Lange, 2014 (intermediate text)

• Brocklehurst's textbook of geriatric medicine and gerontology. 8th ed. Fillit HM, Rockwood K,

Young JB, eds. Elsevier Science; ScienceDirect 2016 (comprehensive text)

Guidelines and standards

• Australian Pharmaceutical Advisory Council. Guiding principles to achieve continuity in

medication management. Canberra: Commonwealth of Australia; 2005

• Australian Pharmaceutical Advisory Council. Guiding principles for medication management in

the community. Canberra: Commonwealth of Australia; 2006

• Department of Health and Ageing. Guiding principles for medication management in

residential aged care facilities. Canberra: Commonwealth of Australia; 2012

• Guidelines for pharmacists providing Residential Medication Management Review (RMMR)

and Quality Use of Medicines (QUM) services. Pharmaceutical Society of Australia 2011.

• Guidelines for pharmacists providing Home Medicines Review (HMR) services. Pharmaceutical

Society of Australia 2011

• Guidelines for pharmacists providing dose administration aids (DAA) services. Pharmaceutical

Society of Australia 2017

• Quality standards and practice principles for senior care pharmacists. American Society of

Consultant Pharmacists 2016

Indicator sets for identifying potentially appropriate prescribing for older people

• Beers criteria 2015

DRAFT prepared 12.12.2018. Property of The Society of Hospital Pharmacists Australia 26

• STOPP (Screening Tool of Older Person’s Prescriptions) and START (Screening Tool to Alert

doctors to Right Treatment) criteria

• STOPPFrail (Screening Tool of Older Persons Prescriptions in Frail adults with limited life

expectancy): consensus validation

• Polypharmacy Guidance, Realistic Prescribing. Scottish Government Polypharmacy Model of

Care Group. https://www.therapeutics.scot.nhs.uk/wp-

content/uploads/2018/04/Polypharmacy-Guidance-2018.pdf

Geriatric medicine journals

• Age and Ageing

• Australasian Journal on Ageing

• Drugs and Aging

• JAGS: Journal of the American Geriatrics Society

• Geriatric Therapeutics Review section in JPPR

Useful websites

American Geriatrics Society (AGS)

• Guidelines and

recommendations

http://www.americangeriatrics.org

Australian and New Zealand Society for

Geriatric Medicine (ANZSGM)

• Position statements

http://www.anzsgeriatric medicine.org/

British Geriatrics Society (BGS)

• Good practice guides, clinical

guidelines

http://www.bgs.org.uk

Coalition for Quality in Geriatric

Surgery

• Guidelines for pre- and peri-

operative care

https://www.facs.org/quality-programs/geriatric-coalition

American Society of Consultant

Pharmacy (ASCP)

https://www.ascp.com/articles/geriatric-

pharmacotherapy

DRAFT prepared 12.12.2018. Property of The Society of Hospital Pharmacists Australia 27

• Key geriatric pharmacy

references and Geriatric

curriculum guide

The ultimate guide for pharmacists

working in care homes. Royal

Pharmaceutical Society (UK) 2016

https://www.rpharms.com/resources/ultimate-guides-

and-hubs/ultimate-guide-to-working-in-care-homes

Polypharmacy Guidance (NHS

Scotland)

http://www.polypharmacy.scot.nhs.uk/

Deprescribing.org

• Guidelines and algorithms for

deprescribing

https://deprescribing.org/

Geriatric medicine podcasts

MDTea

GeriPal

SHPA Contact Details

Address for Correspondence The Society of Hospital Pharmacists of Australia PO Box 1774

Collingwood, Victoria 3066, Australia. Email: shpa@shpa.org.au