The introduction of frontline clinical pharmacy services for patients in their preferred place of care is redefining the traditional role of the specialist clinical pharmacist in palliative care.

This innovative role allows patients, carers and other healthcare professions to access the expertise of the clinical pharmacist in the patients home and is aimed specifically at complex patient groups moving towards end of life.

The aim of the role is to enable patients with more complex drug needs to remain in their preferred place of care, the role sits in a wider specialist community team comprising of physiotherapists, occupational therapists, dieticians, social worker and nurses.

Referrals include

• Complex symptom control i.e. unresponsive to or having experienced side effects and adverse drug reactions with conventional first and second line therapies

• Patients with multiple co-morbidities on complex regimes who require rationalisation of their medicines

• Patients requiring medication review/rationalisation including following discharge from secondary care

• Drug/dose choice for patients with impaired drug metabolism or clearance i.e. renal/liver impairment

• Advice on drug choice, route and formulation for patients with drug administration difficulties

• Issues around access to specialist palliative care medicines in the community setting

• Patients with a non-cancer diagnosis including those with end stage heart failure, renal failure, COPD, liver failure, motor neurone disease etc.

• Patients on palliative chemotherapy

In addition to working with the specialist palliative care team there are many external links these include GPs, district nurses, specialist clinical nurses (community and hospital), consultants, community pharmacists and hospice at home to provide seamless care for palliative patients across the interface. This involves joint professional visits, attendance of GSF meetings or hospital MDT meetings etc.

The Clinical Pharmacy team prescribe for their patients ensuring timely access to specialist medicines and prompt symptom control