GERIATRIC
MEDICATION
AWARDS
THERAPEUTICS
SAFETY
GlaxoSmithKline Medal of Merit 2012-–Rohan Elliott
The GlaxoSmithKline Medal of Merit has been awarded
annually since 1962 in recognition of an outstanding
contribution to the practice of hospital pharmacy or the
professional development of pharmacy. The recipient
of the GlaxoSmithKline Medal of Merit 2012 is Rohan
Elliott, Senior Aged Care Pharmacist at Austin Health, and
Clinical Senior Lecturer and Unit Coordinator in geriatric
pharmacy practice at Monash University.
Rohan has a long history of collaborative research in
aged care highlighted by the recent MedGap project for
which he was the principal investigator. The MedGap
project was ground breaking as it quantied the impact of
using an interim medication chart for patients transferred
from hospital to a residential aged-care facility. The project
won the Victorian Public Healthcare Award: Excellence in
Service Provision 2011.
The use of the interim medication chart has transformed
the interface between hospital and residential care and
is now standard care at Austin Health and some other
facilities. The success of this project has prompted the
Australian Commission on Safety and Quality in Health
Care to commence work on a national interim residential
care medication administration chart.
Rohan has also been actively involved in SHPA,
including serving as treasurer and chair of the Victorian
Branch Committee and is currently a member of two
reference groups. Rohan also participates in many
committees and working groups including the Australian
Commission on Safety and Quality in Health Care’s
National Residential Medication Chart Reference Group
and the Victorian Government’s Medication Reconciliation
Working Party.
The GlaxoSmithKline Medal of Merit for 2012 is
awarded in recognition of Rohan Elliott’s commitment to
hospital pharmacy practice through his ongoing work as a
clinical practitioner, researcher and educator.
Rohan Elliott (C) recipient of the GlaxoSmithKline Medal
of Merit 2012 with GSK National Sales Manager Julian
Taylor (L) and SHPA Federal Vice President Amber Roberts.
Opportunities in Aged Care
Rohan A Elliott
I would like to thank the Society of Hospital Pharmacists
of Australia (SHPA) and GlaxoSmithKline for making this
award available. I am also grateful to the Victorian Branch
for nominating me and the Federal Council for selecting
me. It is a great honour to be recognised by my peers in
this way. Of course I would not be standing here today if
it were not for the support and assistance of many people
that I have been lucky to work with over the years, and in
particular a few key individuals who I will mention later.
Receiving this award made me re!ect on how and why
I came to be doing the work that I have in aged care, and
on the role of pharmacists in aged care. I would like to
share a few thoughts about my journey into aged care and
collaborative research, the aged-care health system, and
the opportunities that exist for pharmacists in aged care.
It is no secret that Australia’s population is ageing.
Average life expectancy has risen from 60 to more than
80 years over the last century. The number of Australians
aged over 65 years is projected to increase from its current
level of around 3 million to over 8 million by 2050.
Rohan A Elliott, BPharm, BPharmSc (Hons), MClinPharm, CGP, FSHP,
Senior Pharmacist, Austin Health, and Clinical Senior Lecturer, Centre for
Medicine Use and Safety, Monash University, Parkville, Victoria
Corresponding author: Rohan Elliott, Pharmacy Department, Heidelberg
Repatriation Hospital, Heidelberg Vic. 3081, Australia.
E-mail: rohan.elliott@austin.org.au
Journal of Pharmacy Practice and Research Volume 42, No. 4, 2012.
The number of people aged over 80 years is expected
to quadruple, leading to a huge increase in demand for
aged-care services. Given that older people are the biggest
users of medicines, the demand for pharmacist services in
aged care can only grow.1 Another factor driving demand
for pharmacist services is the increasing complexity of
medication management for older people. The average
number of drugs prescribed for hospitalised older people
has doubled over the course of my career, from about 4.5
in the early 1990s to around 9 today.2,3 With evidencebased guidelines supporting multi-drug therapy for most
chronic diseases that affect older people, this trend is
likely to continue as the population ages.
My journey into Aged Care
My journey into aged care began in the mid 1990s, when
the then Director of Pharmacy at the Austin Hospital, Bill
Thomson, encouraged me to apply for a travel grant to
visit the USA to explore the role of consultant pharmacists
in nursing homes, and to attend the American Society of
Hospital Pharmacists’ clinical conference. This was just
prior to the time that residential medication management
reviews were funded by the Australian Government,
enabling pharmacists to be remunerated for clinical
services in aged-care homes. Following this study tour I
became accredited to do medication reviews and secured
contracts for the Austin pharmacy with four local aged305
care homes and for a number of years we provided a
clinical service to these homes. Conducting an evaluation
of that service sparked my interest in research and led me
to a position as a research pharmacist at the Centre for
Applied Gerontology.4 There I managed a multicentre
study of prescribing for older hospital inpatients, and
assisted with one of the Department of Health and
Ageing-sponsored studies that led to the Home Medicines
Review program.5,6 These experiences showed me how
research and clinical practice can be combined, and how
collaborative interdisciplinary research can support and
drive the development of clinical pharmacy practice. I
thank Bill for sending me down this path and supporting
my work in those early years.
I then had a few years away from direct involvement in
aged care, when I became involved in clinical teaching at
Austin Health and then postgraduate teaching at Monash
University. This opened my eyes to the potential for
combining teaching with clinical practice and research,
and in 2006 I moved into my current role in which I
have attempted to combine these three areas. I emphasise
the word attempted, because it has been a challenge to
maintain a balance between these three activities – with
research and teaching usually taking up most of my time,
along with other commitments such as reference groups
and committees.
At that time, in 2006, I had formed the view that
pharmacists were under-utilised in aged care. For example
at Austin Health we were providing a basic clinical
pharmacy service to our aged-care wards and we had no
involvement in the many ambulatory aged-care programs
provided by our health service. I also noted that there was
little opportunity for postgraduate study for pharmacists in
geriatrics and aged care. I proposed the creation of a joint
appointment between the university and the hospital with
the goal of developing the aged-care pharmacy service
at Austin Health and postgraduate units for pharmacists
in aged care for the university. I was fortunate to have
the support of my two bosses at the time, Professor
Roger Nation, then head of the Department of Pharmacy
Practice, Monash University, and Kent Garrett, Director
of Pharmacy, Austin Health. I would especially like to
acknowledge the support of Kent Garrett, who shared my
vision for developing and improving aged-care pharmacy
services and using collaborative research to facilitate that
development. Without Kent’s tremendous support I would
not have been able to do the work that has led to this
award, and I would certainly not be standing here today.
Aged Care System
Australia’s aged-care system is complex with a wide range
of programs funded by all three levels of government. The
vast array of programs and different administration and
funding arrangements makes it difcult for patients, carers
and health professionals to understand and navigate the
system. Some reforms of the system have been proposed,
but it is likely that the system will remain complex.
In my experience few pharmacists, even those
practising in aged care, really understand the aged-care
system and its many programs, especially those delivered
outside the hospital walls such as Aged Care Assessment
Teams, Transition Care Programs, Home and Community
Care, Community Aged Care Packages, Extended Aged
Care Packages (and the list goes on). This is a shame,
because there are many opportunities for pharmacists in
this space. In my opinion, pharmacists are under-utilised
in most of these programs, and I am not alone in that view.
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Opportunities in Aged Care
In recent years I have been involved in a number of
projects and committees that have required me to work
closely with other health professionals in the aged-care
sector, such as doctors, nurses, allied health professionals
and managers – from hospital, residential care and
primary care settings. Two things have become very clear.
First, many of the things that pharmacists do are not well
understood and we need to do more to market ourselves.
For example our contribution to continuity of medication
management, such as medication reconciliation, discharge
medication planning and clinical handover is poorly
understood by other health professionals even within
hospitals and is virtually unknown to those outside
hospitals and to consumers. Second, despite the scope of
our role being poorly understood, there is a lot of support
for greater involvement of pharmacists in aged care. This
is because the ageing population and increasing intensity
and complexity of drug therapy are making medication
management a major concern for people working in aged
care, and pharmacists are seen as part of the solution.
Many aged-care programs are managed, coordinated
and/or delivered by allied health professionals, for
example case managers in Post-Acute Care, Transition
Care and community aged-care programs are usually
social workers, occupational therapists, speech therapists,
physiotherapists and nurses, most of whom are illequipped to deal with complex medication issues. There is
little involvement of pharmacists in these programs.
Several times this year I have been at multidisciplinary
aged-care meetings and forums, often as the only
pharmacist present. The role of pharmacists has come
up, and potential to better utilise pharmacists has been
raised, without any suggestion from me. There is clearly a
perception that we could do more.
Proposed areas for greater pharmacist involvement
include: assessment of patients’ medication management,
medication review, risk assessment, regimen simplication,
screening for cognitive impairment and dementia, staff
education and clinical handover. As a profession, we need
to nd a way to tap into and capitalise on this demand, and
get more involved in aged care. Collaborative research, to
develop an evidence-base to underpin expansion of our
role within these services, is one way forward.
The MedGap project, which was a collaboration
between Austin Health, Northern Health and a local
division of general practice, demonstrated how pharmacists
can contribute to clinical handover and continuity of care
in a cost-effective way through the provision of interim
residential care medication charts, and has captured
the attention of clinicians, governments and hospital
managers.7,8 This is just the tip of the iceberg. There is
far more we could do in this area. Our role in continuity
of care needs to be better marketed to governments and
other healthcare funders to ensure that hospital pharmacy
departments are adequately resourced to do this work.
We also need to increase our use of pharmacy
technicians, to enable pharmacists to focus more on direct
patient care. If we don’t increase our use of technicians to
support clinical pharmacy services, our ability to deliver
these services, and job satisfaction, will dwindle as the
intensity and complexity of medication use continues to
rise and length of stay in hospital continues to fall. In a
project at Austin Health, sponsored by Health Workforce
Australia, we expanded the role of a ward pharmacy
technician in subacute aged care, which freed up the
Journal of Pharmacy Practice and Research Volume 42, No. 4, 2012.
MEDICATION SAFETY
pharmacist to spend more time on clinical tasks such as
medication review, medication management assessment
and discharge planning, and resulted in less unpaid
overtime and greater job satisfaction.9
Managing one’s own medications is an instrumental
activity of daily living – an activity a person needs to be
able to perform to live independently.10 Assessment of
older patients’ medication management is an area in which
I think pharmacists could certainly do more. I was recently
talking to a social worker from our Aged Care Assessment
Team who assesses inpatients referred to the Transition
Care Program. When I asked her how she determined
patients’ level of functioning and post-discharge support
needs, she indicated that for mobility she referred to
the physiotherapist’s assessment, and for tasks such as
dressing, washing, shopping and cooking she referred
to the occupational therapist’s assessment. However, for
medication management there was no reference to the
pharmacist, nor any attempt to objectively establish what
the patient is likely to be capable of after discharge. Often
cognitive function (e.g. Mini-Mental State Examination
score) is used as a proxy for medication management
ability; but this is a !awed approach. And this is not
unusual. I have had similar conversations with a liaison
nurse who reviews inpatients referred for Post Acute
Care and community nursing services after discharge,
and also with community nurses who receive referrals
for medication management support in the community.
Decisions about medication management are often made
in an ad hoc way, without formal or structured assessment.
Nobody is routinely assessing and documenting patients’
medication management capacity as part of care planning.
In other projects with colleagues at Austin Health
we have identied a range of problems and gaps in
medication management for patients referred to aged
care outpatient clinics and Aged Care Assessment Teams,
again highlighting the under-utilisation and potential roles
for pharmacists in these services.11,12
It is this under-utilisation of pharmacists, and potential
for pharmacists to contribute more towards improving the
care of older people, that has driven me to do the work I
have done. I have tried to educate pharmacists about the
various aged-care programs and how they can contribute
to them and refer people to them, through the postgraduate
units that I teach. I have tried to increase pharmacists’
involvement in these programs through collaborative
inter-disciplinary research, by quantifying some of the
medication-related problems that exist and demonstrating
how pharmacists can address these.
Given the need and the opportunities that exist in
aged care, I would encourage pharmacists to look for and
pursue these opportunities within their organisation and
beyond. Based on my experiences, I offer a few tips to
those seeking to develop roles or services:
• Take an evidence-based approach. Describe and
quantify the problems using robust methodology,
in order to make a strong case for change and to
demonstrate that the change once made will improve
patient care. For example with the MedGap project,
until we collected our baseline data to describe
and quantify the gaps in continuity of medication
management we had difculty getting the attention
and buy-in from some key stakeholders.
• Collaborate with other disciplines and with consumers.
Aged care is a multidisciplinary environment, and it
is vital that we work closely with others in the team.
Not only will this increase the chances of success
but in my experience an invaluable spin-off is that it
opens others’ eyes to what pharmacists do, and what
we can do.
• Look for grant funding opportunities. Developing new
service or workforce models and undertaking good
quality research to underpin new models are labourintensive endeavours. Access to funding makes it a
lot easier to undertake projects in a systematic and
evidence-based way, and helps to avoid the project
falling over when staff nd that they don’t have time
to work on it, which I have seen happen many times.
• Be persistent and patient. These things rarely happen
quickly. My projects have all had long lead times,
often with failed attempts to obtain funding. It took
us almost 2 years, and three attempts before we were
able to get the funding for the MedGap project. Some
of my projects have just never got off the ground.
• Take steps to ensure your new service or care model
is generalisable and sustainable. Collaborate with
another organisation and/or seek input from people
outside your organisation to ensure that what you are
doing will have wide applicability.
I would like to conclude by acknowledging a few
people. I have mentioned Bill Thomson, Roger Nation
and Kent Garrett, who supported me and were great
role models and mentors. Another person who was an
important role model and mentor, especially in my early
career, is Graeme Vernon. Associate Professor Michael
Woodward, Head of Aged Care, Austin Health has been
a great supporter of my aged-care research and I thank
him for that. There are many others I have worked and
collaborated with who I don’t have time to mention
individually. However, I would like to thank the pharmacy
team at Austin Health for being a great bunch of people
to work with. We are lucky to have a culture that supports
innovation and quality improvement, where staff are
willing and supported to try new ways of doing things, to
enhance patient care. And last, but not least, I thank my
family for their love and support.
Journal of Pharmacy Practice and Research Volume 42, No. 4, 2012.
307
References
1. Morgan TK, Williamson M, Pirotta M, Stewart K, Myers SP, Barnes J.
A national census of medicines use: a 24-hour snapshot of Australians aged
50 years and older. Med J Aust 2012; 196: 50-3.
2. Turner CD. Drug use in the elderly: results of a multicentre audit [abstract].
Proceedings of the Conference of the Victorian Branch of The Society of
Hospital Pharmacists of Australia; 1992 Nov 13–15; Lorne, Victoria.
3. Elliott RA. Reducing medication regimen complexity for older patients prior
to discharge from hospital: feasibility and barriers. J Clin Pharm Ther 2012; 37:
637-42. Doi:10.1111/j.1365-2710.2012.01356.x.
4. Elliott RA, Thomson WA. Assessment of a nursing home medication review
service provided by hospital-based clinical pharmacists. Aust J Hosp Pharm
1999; 29: 255-60.
5. Elliott RA, Woodward MC, Oborne CA. Quality of prescribing for elderly
inpatients at nine hospitals in Victoria, Australia. J Pharm Pract Res 2003; 33:
101-5.
6. Sorensen L, Stokes JA, Purdie DM, Woodward M, Elliott R, Roberts MS.
Medication reviews in the community: results of a randomized controlled
effectiveness trial. Br J Clin Pharmacol 2004; 58: 648-64.
7. Tran T, Elliott RA, Taylor, SE, Garrett K. Development and evaluation of a
hospital pharmacy generated interim residential care medication administration
chart. J Pharm Pract Res 2012; 42: 100-5.
8. Elliott RA, Tran T, Taylor SE, Harvey PA, Belfrage MK, Jennings JJ, et
al. Impact of a pharmacist-prepared interim residential care medication
administration chart on gaps in continuity of medication management after
discharge from hospital to residential care: a prospective pre- and postintervention study (MedGap Study). BMJ Open 2012; 2: e000918.
9. Elliott R, Perera D, Garrett K, Woodward M, Szysz A, Marriott J, et al.
Improving medication safety for subacute aged care patients through expanded
pharmacy assistant (technician) support for clinical pharmacy services. Final
report. Adelaide: Health Workforce Australia, Workforce Innovation and
Reform: Caring for Older People Program; 2011.
10. Elliott RA, Marriott JL. Review of instruments used in clinical practice to
assess patients’ ability to manage medications. J Pharm Pract Res 2010; 40:
36-42.
11. Elliott RA, Woodward MC. Medication-related problems in patients
referred to aged care and memory clinics at a tertiary care hospital. Australas J
Ageing 2011; 30: 124-9.
12. Elliott RA, Martinac G, Campbell S, Thorn J, Woodward MC. Pharmacistled medication review to identify medication-related problems in patients
referred to an Aged Care Assessment Team: a randomised comparative study.
Drugs Aging 2012; 29: 593-605.
Rohan Elliott delivered his oration on 2 November 2012 at
the 38th SHPA National Conference in Canberra.
Australian Clinical Pharmacy Award 2012–Jason Roberts
The Australian Clinical Pharmacy award has been awarded
annually since 1997 to a member of SHPA for outstanding
contribution to clinical pharmacy practice. The winner of
the Australian Clinical Pharmacy Award 2012 is Jason
Roberts, consultant pharmacist at the Royal Brisbane and
Women’s Hospital where he specialises in intensive care
medicine and infectious diseases, and an NHMRC Health
Practitioner Research Fellow at the School of Medicine,
University of Queensland.
Jason is internationally recognised and highly regarded
by his peers as an expert in antimicrobial use in the
critically ill, having completed his PhD in this eld. Jason’s
contribution to clinical pharmacy practice is exhibited in
his clinical expertise, leadership and commitment to the
development of clinical pharmacy practice.
Despite still being in the early stage of his pharmacy
career, Jason has already demonstrated his high standards
of clinical research. He has been extensively published,
successfully obtained considerable research grants and is
regularly invited to national and international meetings.
He is also in demand as a reviewer for peer-reviewed
journals and ethics committees.
Jason is a highly skilled and well regarded clinical
educator. He is also known for his generosity of time and
effort towards mentoring and encouraging colleagues
junior and senior.
Jason’s leadership and contribution to his profession
have also been evident in his involvement with SHPA.
He has held an executive position on the Queensland
Branch Committee since 2004 and is currently its chair;
Jason Roberts recipient of the Australian Clinical Pharmacy Award
2012.
during this time he instigated improved access to CPD
for Queensland members. Jason is also a member of two
SHPA Committees of Specialty Practice – Infectious
Diseases and Critical Care.
Jason’s dedication to clinical pharmacy practice as an
educator and researcher make him a worthy recipient of
the Australian Clinical Pharmacy Award 2012.
Australian Clinical Pharmacy Award Oration
Jason Roberts
It is with great humility that I accept the Australian
Clinical Pharmacy Award. I thank the Queensland
Branch for their nomination and the Federal Council for
their consideration. I also congratulate the high-quality
nominees for this award. Like previous awardees, I stand
before you grateful for our profession’s history and excited
about our future.
Jason Roberts, BPharm (Hons), BAppSc, PhD, FSHP, Pharmacist Consultant,
Royal Brisbane and Women’s Hospital, NHMRC Research Fellow, Burns
Trauma and Critical Care Research Centre, The University of Queensland, and
Adjunct Professor and Clinical Director–Allied Health, Australian Centre for
Health Services Innovation, Queensland University of Technology, Brisbane,
Queensland
Corresponding author: Dr Jason Roberts, Burns Trauma and Critical Care
Research Centre, The University of Queensland, Royal Brisbane and Women’s
Hospital, Brisbane Qld 4029, Australia.
E-mail: j.roberts2@uq.edu.au
308
I would like to tell you my story, about how I moved
from being a science–law student and pharmacy assistant,
to a pharmacist clinician–scientist.
The rst part may be obvious. I worked part-time
as a storeman in a pharmacy under a strong Queensland
pharmacist, Jacqui McInerney. My father who is also a
pharmacist researcher, Professor Michael Roberts from
The University of Queensland and University of South
Australia helped me get this job and unknowingly I had
commenced on my future professional pathway.
Very quickly, I realised the value of forward pharmacy
and how it can assist patient care. So I left my hometown,
Brisbane, and headed to James Cook University where
John Doonan and Ian Heslop led a new program of
pharmacy education in Townsville.
Journal of Pharmacy Practice and Research Volume 42, No. 4, 2012.