Title: Incorporating a clinical pharmacist in an outpatient palliative care team
Crystal Rim, PharmD; Sharon Leigh, PharmD, BCPS; Linda De Sitter MD, MPH; Mary Grant, ANP; Dana Nguyen, PharmD
Palliative care is a growing field in medicine that focuses on delivering care that improves quality of life for patients with serious illnesses. Often, the goals of palliative care differ from traditional goals of medicine. Currently, there is limited data demonstrating the integration of pharmacists in the palliative care setting. The purpose of this quality improvement is to evaluate the clinical pharmacist’s role within an outpatient palliative care team when performing medication reconciliation and review. Medication review includes de-prescribing high-risk medications and optimizing medications in symptom management. Between January and February 2020, the clinical pharmacist interviewed patients referred to the outpatient palliative care service through three different methods: telehealth, pharmacy consult and telephone. The clinical pharmacist provided recommendations to the outpatient palliative care nurse practitioner and primary care provider for medication optimization, symptom management and de-prescribing based on STOPPFrail and Beers Criteria. Data from 19 patients were analyzed. One patient was excluded from analysis due to death. Five patients were interviewed through telehealth. Two patients were directly consulted for pharmacist review by the outpatient palliative care nurse practitioner. Seven patients were interviewed through telephone, of which 4 patients were referred to hospice following palliative care consult. Of 19 patients, 64 total recommendations (29 medication discontinuation, 30 medication optimization, 5 symptom management) were made. Six recommendations were accepted by the provider (3 medication discontinuation, 3 medication optimization). The average time spent on chart review for each patient was 1.5 hours. Pharmacist involvement in outpatient palliative care may be valuable. However, many barriers to providing meaningful interventions were identified in this study. While telehealth provided the convenience to the patient and caregivers, utilization was limited due to lack of standardization of technology. Telephone interviews allowed proper medication reconciliation prior to the palliative care visit, but non-medication related issues may be prioritized after the visit. Finally, pharmacy consult from palliative care nurse practitioners allowed more efficiency, but it did not allow formal pharmacist integration in the outpatient palliative care team. Further studies quantifying the pharmacist role in outpatient palliative care are warranted.https://digitalcommons.psjhealth.org/pharmacy_PGY1mn/1000/thumbnail.jp
