Palliative care and Pharmacist- Part 4

In the UK, the Government has recognised the importance of the pharmacist’s role and provides funding to hospices to enable them to purchase pharmaceutical advice. This advice, which may be provided by either hospital or community pharmacists, consists of individual patient prescription monitoring, recommendations for formularies, advice on medicines policies, discharge planning and the use of patients’ own drugs and advice on stock control and the safe storage, administration and disposal of medicines Many patients, especially towards the end of life, have their medicines administered over24 hours through a syringe driver. There is little published data available on the compatibility of different injectable medicines in a syringe driver and pharmacists are often asked for professional advice on the stability and suitability of combinations of two, three and even four drugs in a syringe.

3. Specific preparations and products
The pharmacist can help the doctor in identifying specific products, needed in palliative care: specific preparations, adapted galenic forms, medical devices (specific bandages, needles, catheters…), etc. Pharmacists advise on the formulation and preparation of medicines for people with swallowing difficulties.
The pharmacist is legally responsible for the quality of all the products he delivers, with particular attention to sterility when applicable. While these products are normally known and regularly used in hospitals, they should and can be used as well at home in palliative care. Given the necessary documentation and training, as part of his continuing education, the pharmacist can help to identify them and make them available. Pharmacists can also rent specific tools, such as hospital beds, syringe drivers, enteral feed pumps and other nursing devices. While maybe this service cannot be offered through every pharmacy, in many areas some pharmacists have developed it and help out their colleagues or their patients.

4. Low threshold and 24/7 service
Pharmacists are known for their “low threshold”, meaning that patients, family or health
Professionals can always freely ask for advice and assistance. The fact that pharmacies, through regular duty services, can offer assistance and products 24 hours a day, 7 days a week, is an important asset. The continuity of care can and should be guaranteed, although – as stated in the first point – the aim should be to use as much as possible the services of the regular pharmacist of the patient. Many community pharmacists are involved in the distribution of rarely used drugs to ensure that healthcare professionals and patients have access to these medicines when they are needed. During normal working hours, most medicines can be obtained from wholesalers within a matter of hours. However, at night and at weekends, deliveries are not as frequent. In different countries community pharmacies organised a system to stock small amounts of rarely used medicines for palliative care in some community pharmacies. Pharmacists often provide information and advice about patient support services such as self-help groups, palliative care services, and so on. It is clear that communication with other healthcare providers, and certainly with the General Practitioner - are absolutely necessary.

Together with the other members of the team that is formed around a patient in need of palliative care, the pharmacist has a well-defined and unique role in order to guarantee maximum comfort, based on the rational and optimal use of medication and other specific products

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