Overview
Initiative type
Model of Care
Status
Deliver
Published
June 2026
Summary
The purpose of the project was to improve access to a specialist palliative care pharmacist to community-based care of people with a life-limiting illness
Dates: July 2024 - February 2025
Implementation sites: Robina Hospital
Partnerships: Community patients referred to the Gold Coast Specialist Palliative Care Service
Aim
Improved access to a palliative care pharmacist will improve patient care and reduce medication errors and the likelihood of preventable medication-related hospitalisations, as well as reduce errors and costs related to polypharmacy.
Outcomes
During 72 days of patient-facing service, the following outcomes were achieved:
- 26 telehealth consultations
- 23 home visits
- 43 telephone calls 143 patients with a life-limiting illness who had been referred to the Gold Coast Specialist Palliative Care Service were referred to a trained Palliative Care Pharmacist. One hundred and thirty (91%) of these patients were reviewed by the pharmacist (average 2 patients per patient-facing day).
- 184 drug-related issues were identified, and 317 recommendations were made and accepted by the treating clinician (2.4 recommendations per patient).
- Resource development: update of the "Gold Coast Pocketbook of Palliative Medicine", Palliative Support Pharmacy list, Opioid Shortage Management Plan
Background
In Australia there are over 187,000 preventable medication related hospital admissions each year which costs the healthcare system $1.4 billion per year. Seventy per cent of Australians say they would prefer to spend their final months to weeks at home, however, access to pharmacists in the palliative care team is limited to a weekly out-patient clinic at Gold Coast University Hospital (GCUH) and Robina Hospital. The use of prescription medications to provide relief from pain and other distressing symptoms is an important part of palliative care, polypharmacy is common and these people are identified as being at a high risk of medication-related problems and an increased likelihood of experiencing an adverse event resulting in unplanned hospital admissions. Improved access to a palliative care pharmacist will improve patient care and reduce medication errors and the likelihood of preventable medication-related hospitalisations, as well as reduce errors and costs related to polypharmacy.
Currently, people with palliative care needs living at home on the Gold Coast have limited access to a palliative care pharmacist, through a weekly out-patient clinic at Robina Hospital and GCUH, in person or via videoconference from their own home. Access to a medication review by a Clinical Pharmacist trained in Palliative Care in their own home is the preferred setting but is currently only available by referral to a pharmacist accredited to perform Home Medicine Reviews. This referral process is not commonplace, and the Credentialed Pharmacist is not likely to have specific palliative care training and experience. As a result, this process is unable to address the rapidly changing symptom burden profile and complex drug regimens in a timely manner and wouldn’t guarantee the necessary knowledge and skills required. The project investigated the impact of improved access to a Specialist Palliative Care Pharmacist for community-based care of people with a life-limiting illness through home visits, videoconference or telephone calls. It was estimated from current service data that a palliative care pharmacist would be able to see on average four patients per day.
Methods
The project provided access to a specialist palliative care pharmacist for three days per week over an eight-month period from July 1st 2024 to February 21st 2025 (total of 72 patient-facing days).
The key stakeholders involved in the project were:
- Gold Coast Specialist Palliative Care Service (GCSPCS) multidisciplinary team
- General Practitioners
- Community pharmacists
- Credentialled pharmacists
- Gold Coast Primary Health Network (GCPHN)
- Community patients referred to the GCSPCS
Pharmacist referral criteria were developed to assist the triage process in identifying which patients would most
benefit from a pharmacist medication review. These included:
- Polypharmacy, complex medication regimen
- use of alternative/complementary medication
- worsening symptoms and/or symptoms suggestive of an adverse drug reaction
- no medication plan in ieMR
- swallowing difficulty
- anticipated deterioration
- suspected non-adherence
- recent significant changes to medication
Consultation allocation was managed by the pharmacist and included home visits, telehealth consultations or telephone calls. The pharmacist
provided targeted medication education, risk assessments, side-effect management and medication adherence support
Discussion
For the project to succeed the referral process required education and support provided to current members of the community team from the pharmacist. This included use of pharmacist specific referral criteria and a palliative care pharmacist specific email to help streamline the process.
Documented impact
- Patient benefits: medication adherence support: improved culturally responsive patient/carer understanding of complex medication regimens to support patient care at home. Target achieved: >50% (actual 72%) patient/carer accessed written Interim Medication Records & >10% (actual 13%) accessed Consumer Information.
- Organisational benefits: reduced costs related to medication adverse events: improved patient care, reduced medication-related harm and avoidable hospital admissions.
- Community benefits: increased support and advice provided to community pharmacists: facilitated safe and timely supply of palliative care medication to people at home. Target achieved: 100% of patient/carer who requested assistance in medication supply through a community pharmacy were actioned by pharmacist.
- Staff benefits: improved access to a comprehensive medication history providing increased inter-disciplinary support and advice to other team members (medical, nursing), preserving time and reducing medication-related errors. Target achieved: >80% (actual 85%) of patients received a Medication Review. Clinician Feedback survey results Results from an Improvers Project clinician feedback survey demonstrated the high acceptance and utility of the pharmacist role in the specialist palliative care community service and confirmed the need to continue this role in a full-time capacity. All participants believed that the pharmacist’s input in medication management improved patient outcomes in palliative care by the provision of a Medication List, advice on pain and symptom control, improving patient and carer education on medication use, providing expert advice on drug interactions and side-effects, improving medication access.
- Participant suggestions on any changes to the service:
- Recommendations to continue as a permanent, full-time service, expanding into Consultancy-Liaison
- Increased collaboration with pharmacist, particularly for patients on multiple medications or with complex pain/symptoms.
- Independent follow up by pharmacist if changes to medication occur. A reduction in the number of patients
who had been projected to receive a pharmaceutical review (average of four patients per patient-facing day) is proposed to be due to time allocated to resource development, a high level of medication complexity and time allocation limitations. Strengths of the project included involving a pharmacist with palliative care experience and good knowledge of the established community team. This project has led to a similar project which has been rolled out for twelve months from April 2025 (2 days per week), on a national
level to six pilot sites (including the Gold Coast) funded through a National Grants Project.
References
1. Chess-Williams L et al BMC Palliative Care (2024) 23:172; Cross-sectional study to evaluate patients' medication management: incorporating a pharmacist into a community specialist palliative care telehealth service
2. Hussainy et al. BMC Palliative Care (2011) 10:16: Piloting the role of a pharmacist in a community palliative care multidisciplinary
team: an Australian experience
3. Integrating palliative care and symptom relief into primary health care: a WHO guide for planners, implementers and managers. Geneva: World Health Organization; 2018. Licence: CC BY-NC-SA 3.0 IGO.
4. The Pharmacist's Role in Palliative Care: accessed 27/02/2026 https://www.news-medical.net/health/The-Pharmacists-Role-in-Palliative-Care.aspx
Key contact
Lorna Chess-Williams
Senior Palliative Care Pharmacist
Robina Hospital