Adopting a person centred approach to dementia care is a never-ending process and it is a professional journey I am deeply committed to as a pharmacist.
It requires a strong commitment from health professionals as individuals, and within the wider teams in which we work. It also requires commitment from the top down within organisations, both in health and social care. Individuals and their families, striving to live well with dementia, need this from us as a matter of urgency.
Within care provision compliance is no longer enough. It is quality outcomes that define us all as care providers. I believe pharmacists can be at the heart of this. For example as pharmacists we can adopt an ethos towards medicines, in whatever setting we work, ensuring we spend time to support individual patients, wherever possible. We can support patients to understand the value of their medicines and the risks and benefits of treatment.
To support those living with dementia we must ensure medicines are reviewed regularly and where medicines are requested related to behaviours requiring support, we can educate and support the families and carers of individuals to consider appropriateness, alternatives, optimisation and review. We should always strive to ensure that every person has a feeling of enablement and involvement with their medicines.
Pharmacists have traditionally been viewed as being involved in the medication process but in my opinion our true value has not always been seen. We have not appreciated just how great an impact we can and do have at the coalface of care. We are more than medicines; after all medicines treat diseases and we are part of an emerging integrated care system for individual people. In short we care for people, including those who are striving to live well with dementia.
Pharmacists now belong in multidisciplinary teams where they can use all their core skills, which include not only medicines optimisation but holistic support for patients and carers. This is never more apparent than in support for the frail elderly, especially those being cared for at home or in residential care settings where simple support can make all the difference. So often it is a simple intervention that can have the greatest outcome.
As pharmacists are stepping up to work streams in GP services and Health and Social Care settings we can begin to see the true benefit of our skill set, knowledge and drive for positive outcomes. As a profession I believe we are solutions focused.
There is much work to be done now across care interfaces in understanding safe medication pathways, incidents and learning outcomes and how we manage and optimise medicines. But for me we also need to identify how we can be part of positive care planning processes ensuring all the dots are joined up. This is of the utmost importance, it is the human face of pharmacy, how we support positive care planning to include, when needed, all aspects of anticipatory care planning and advanced care planning.
Medicines reviews for the elderly frail should consider appropriate deprescribing within the landscape of an individual’s overall health and wellbeing. Pharmacists who have the skills should be given the time to deliver these supportive reviews.
I spend much of my time now in the care home setting with an Admiral Nurse colleague, and I never cease to be amazed at the complexity of care in this environment. It is here that we have taken a fresh look at care planning and are working closely with our health colleagues to develop a care setting for those who require extra support with behaviours or distress, which will hopefully open in June 2016.
Pharmacists are in general good communicators and if ever a setting needed a voice it is here in dementia care where we can be advocates for residents and their families. Pharmacists can work closely with the multidisciplinary team to ensure medicines add the value intended by the prescriber. We can also ensure they are part of a wider range of interventions including environmental adaptations and non-pharmacological interventions. This should have a positive effect on the health economy as a whole but the truth is it should have a far greater intrinsic value as it will benefit individual people, all of whom have a name. In short we can help improve quality of lives of individuals and this in turn can help families and carers in the wider circle of care.
These close working relationships between healthcare professionals, patients and care providers will define care provision in the future in health and social care settings. This has been recognised in the NHS Five Year Forward document and hopefully we pharmacists will be early adopters of its concepts.
As a profession we embrace the science of care, we are all conscious of the cost of care, but the jewel in the crown will always be the art of care because it is that which ensures the best outcomes for our patients.
Anne Child is speaking at the King’s Fund event ‘Commissioning person-centred care for vulnerable groups: what role does pharmacy play?’