|
| NPT construct | Additional, relevant quotes which further support the NPT construct findings |
|
| Coherence | |
| Value added compared to usual practice | “When I first came in here, they put me on a lot of medication that I didn’t need. And they left – well, when I say I didn’t need, sort of things like for constipation and this, that, and the other, but nobody ever came back until I saw OSP 6 and [they] actually went through it with me. And a lot of that medication was taken off, which was great’ [R6.1] |
| “So in that situation [due to my husband’s issue swallowing medicines], I have found it’s been good to have OSP 3 to be able to bounce things off” [F3.2] |
| “[the OSP1]’s one of those people that you can [ask questions of] without feeling as though [OSP1]’s gonna think, “Oh gosh.”[OSP1]’s not one of those, and I think that’s important because it might just be a silly question but to you, if it’s bugging you, you know?” [R1.3] |
|
| Reduction in medication complaints | “And, again, I think families feel more comfortable if they know that if they’ve got a concern or a worry, that there is someone [the OSP] there that they can have a conversation with as well around medications” [NP3.1] |
|
| OSP interactions with residents | “But with OSP1, [OSP1] sees them like almost every week, [OSP1] knows them, so [OSP1’s] recommendation is a bit more thought out… That only comes from someone who knows the patient” [GP1.1] |
| “OSP3 knows the patients better as well. So [OSP3]’s on-site, so [OSP]’s aware of the patient’s comorbid condition and also their background as well” [GP3.1] |
|
| Prescriber perception of benefit (or not) of OSPs | “[OSP1]’d look and see well this patient is on frusemide and potassium and their levels haven’t been checked for months, so it’s probably sensible to do something and [OSP1] made suggestions like that all the time which is sensible enough” [GP1.2] |
| “[OSP3]’s on-site and it’s much easier getting together to see the patient and talking through and good communication, less misunderstandings and it’s more effective” [GP3.1] |
| “So those things where there’s someone there working and understanding the difficulty we’re seeing in that environment, and I think seeing what might be going on, because I know OSP 3 has picked up on things [OSP3]’s observed that no one’s aware of” [NP3.1] |
| “Like the thing is it [the OSP at the RACF] didn’t make much difference to my work… I felt like [OSP 2] tried [their] best. Like I’m not a part of RACF 2 and I just think the role could be [more] developed there though that’s all” [GP2.1] |
| “It was particularly valuable in the team and made my job easier [having the OSP at RACF 4], though it wasn’t necessarily educational [for me]” [GP4.1] |
| “So the interaction has mostly been – well, in fact, I think all of it has been asynchronous through some form of electronic communication… without the dialogue, without the relationship in it, yeah, it felt bureaucratic… There wasn’t the opportunity to have dialogic conversations around patients, and so that relational aspect was missing…Now, that same mode of communication [electronic communication], had there been relational working, shared purpose, trust, would actually have been very effective” [GP5.1] |
|
| Cognitive participation | |
| Key people driving OSP to become part of routine practice | “ We’ve always tried to make [OSP1] feel one of us because [OSP1] is one of us. [OSP1]’s one of our staff at the moment. And so, everyone’s just treated [OSP1] like [OSP1] was one of us” [M1.1] |
| “So basically, I had to inject myself and say, “Look, I can take that workload from you. I can do that for you. I can help with that,” and really push a little bit at the beginning to say, “Look, I am actually here to help you and make your life easier.”” [OSP 1] |
| “I’ve been on outings with the residents when they were short-staff to help – for example, we took four residents to the RAAF… So I went along to that. I also helped when I drove the bus to get three residents to the doctor’s surgery for their vaccinations… So I try and do whatever is needed when it’s needed, and answer any questions” [OSP6] |
|
| Importance of establishing relationships | “I think the implementation of it [the OSP intervention] is really important and the focus on the relational stuff is really important” [GP5.1] |
| “ I think it goes with any new person that comes into a new position, they have to build the relationships and establish themselves a little bit. I was expecting that and it wasn’t any harder or more difficult than I expected” |
| [OSP1] “First couple of months – trying to build up a relationship and rapport with doctor or different staff like carer or even kitchen staff, just everyone” [OSP4] |
|
| Legitimately interacting and working with OSPs | “I’m actually surprised that it hasn’t happened before. I mean, <laughs> we’re new in aged care facilities anyway, because my father’s only been there for a relatively short period of time, but I guess I’m surprised that there wasn’t an on-site pharmacist before.” [FM5.1] |
| “there’s certainly quite a few examples where just having that follow up from OSP 6 has been very helpful, particularly because as a GP, sometimes you’re under the time pressure and then I was not able to liaise with all the other practises and look everything up” [GP6.1] |
| “I think people in aged care are usually on quite a lot of medication, so it was good that [OSP5] contacted us and spoke to me about it and asked what I’d like to do” [FM5.1] |
| “[There was talk] about trying to encourage staff to get their flu shots, and I said, “Well, I can run a clinic here on-site. I can do it all,” and they were like, “Well how do you get the stock,” and I said, “I can order it for you. I can do all of that and all you have to do is tell the staff to show up,” so that went quite well, and then because it went quite well, then they kinda volunteered me to do the residents [flu vaccinations]” [OSP6] |
|
| Invested in working and interacting with OSPs | “But with [OSP3] having access to our doctor – the doctor puts something on the document and then OSP 3 will follow it up because [OSP3] sees the corrections on there. So, [OSP3]’s very active in what [OSP3]’s doing in there” [R3.1] |
| “[OSP1] is [working with the doctors and nurses]. [OSP1]’s with the resident[s]. Sometimes I have to go up there three times[so that I can speak with OSP1]” [R1.1] |
| “It’s a very good thing because – I mean, we’ve got nurses in here all the time, but [OSP6]’s – well, [OSP6]’s more in tune with the medications and so on, so – yeah, it is a good thing. You can ask [OSP6] anything you like about the medicine that you’re on… It made me feel very safe when [OSP6] came in and sat down with [OSP6] paperwork and asked me questions, that [OSP6] was interested in me enough to do that” [R6.1] |
|
| Collective action | |
| OSP impact on staff workload | “ If we didn’t have the pharmacist on-site all the duties that [OSP3] does would be part of registered nurses on-duty job and probably a little bit of mine and the care coordinator’s as well” [M3.1] |
| “And it’s taken quite a load of the nursing staff because OSP 4 has taken on some of the auditing which has been fantastic, I think, because she knows exactly what she’s looking for” [M4.1] |
|
| Prescriber perception of OSP impact on their workload | “If I ask the RN, I never really got – it was difficult to get an answer of whether they’ve been given this medication or not, but with the pharmacist, I get a very quick response” [NP3.1] |
| “ It would have taken longer [to conduct medication rounds], I would have made the same decisions, but it’s nice to have [OSP4 go on the rounds]” [GP4.1] |
| “There was maybe a little bit more workload because OSP 6 will be scrutinising a lot of the medication, a lot more than I would, so the changes that has to be made” [GP6.1] |
| “So [OSP1] goes through for the medication and brings up things that we are probably overlooking and we usually look at those” [GP1.2] |
| “Probably a slight increase in the workload. So just go back to what I’ve said earlier around – it just felt like another message” [GP5.1] |
|
| Easy to integrate working and interacting with OSP into RACF routine practice | “I then say to OSP 3 when I go, “This is what’s happened today. I’ve told them they have to be giving it, they need a little bit of support.”… [OSP3]’s then the consistent person there who can then reinforce what we’re saying” [NP3.1] |
| “Yes, [OSP1]’s get onto it. See I have with this asthmatic puffer in the morning and the night myself, but the thing is I’ve got to make sure I don’t run out. The girls over here, if you asked them to do something, you know you’ve got to ask them two or three times to get it. I realise they’re busy, but, really, I think, “Here we go again. How long will this gonna take?” whereas with OSP 1, [OSP1] comes to me later and said, “Look, I got such and such.” So that’s what I like about OSP 1.” [R1.4] |
| “Happy to talk to [OSP1] anytime, but [OSP1] won’t be here anymore so haven’t given it much thought as haven’t come to rely or depend on [OSP1 as there’s] not much reason for us to get together’ [R1.5] |
| “It was good to talk to [OSP3] because, you know, the RNs, busy people again, but they are part of the workforce here and they’ve got allegiance, of course, to the organisation they belong to, and that’s totally understandable. It was just nice to feel that I could talk to someone about these things, the medication side of things” [FM3.1] |
|
| OSPs did not disrupt existing relationships | “Everyone is looking at me like,“OSP 3, can you make friends with all the doctors because we need all the charts signed,” and it’s a big process <laughs> and that happens every four months actually” [OSP3] |
| “[OSP4] will often suggest something or question something that we wouldn’t have otherwise. The GPs have said they’re very happy to have [OSP4] on the rounds” [RN4.1] |
|
| Reflexive monitoring | |
| Ongoing specific medication management support | ‘but OSP 6 went through the dispensing record prior to hospital admission and one of the things that she discovered was while the patient was on Prolia which is for osteoporosis, and this patient haven’t had it for months, as in certainly more than six months… So as a result, I was able to restart treatment for osteoporosis and then go from there” [GP6.1] |
| “So I went to see a patient at one of the facilities when the [OSP] was there … And we sat together and went through the med chart one by one and talked about how to do that deprescribing in a safe way and I found that was a really positive interaction” [NP 2] |
| “We were lucky enough that OSP 6 was also able to do immunisation around the flu this year… So we basically had all of our staff done within a month of the flu shot coming out, and that’s never, never happened here before” [M6.1] “So whenever I’m watching telly, I have to have a hanky there because I get – not a lot and you wouldn’t call it drooling but it’s extra saliva, and so I get that and I ask OSP 1 to check my medication – well [OSP1] said [they] would, and it’s not my medication” [R1.1] |
| “[OSP5] did e-mail us about a week ago too, saying that [they’d] looked at my father’s medications and [OSP5] picked up the fact that he’d been on a particular medication which does have some side effects and he has been on it for some time and [OSP5] just pointed out that this particular medication has some side effects and were we aware of that, and what –did we want [OSP5] to speak to his GP about it or so on’ [FM5.1] |
|
| Acceptance of OSPs | “with somebody on the site to follow up on the patient and advise on what to do on time or in a timely manner, I think that is a very good reason for us to have an on-site pharmacist” [GP1.1] |
| “The staff obviously think a lot of [OSP3]… I think [OSP3] is very much part of the organisational team” [NP3.1] |
| “So, yeah, going from someone who’s worked in aged care for 15 years and not having that complemntary there, of having a pharmacist to go to [on-site], I can say the difference is you can actually see the difference with medication management has improved immensely” [M6.1] |
| “[OSP1] knows most of the staff, and how can I explain? [OSP1] just fits in here extremely well… I just wish to God [OSP1] wasn’t leaving… Is there any way we can steal [OSP]?”” [R1.2]” |
| I think when people get to know you then they trust you more… [and] you become part of that family… I think so yeah [that OSP has become part of the team]” [R1.3] |
| “It’s added an extra dimension… being able to talk to someone who can listen, check things out, etcetera, and a personality you feel that you got, not only me, that you’ve got a comrade on-site” [R4.1] |
|
| Lack of funding for OSPs | “if they could see their way clear to fund a pharmacist, I think it’d be a good outcome for every aged care, to be honest with you, because it lets you know there’s someone there looking over things on a regular basis that’s in the facility and not having to be called to come in” [M1.1] |
| “It’s purely funding. There is no money in anybody’s budget set aside. We’ve just re-budgeted again and there’s nothing in there for a pharmacist sadly” [M4.1] “we’re going to be very, very sad that OSP 6 is leaving us if we don’t get more funding… I definitely would go to bat for that one [having OSP 6 if funding was available].” M6.1 |
|
| Potential “broker” role | “I just let them know that if they’re [other residents are] really bothered [about their medication], and some of them are, I tell them where they can go, where the office is, who to ask for [the OSP], and I know they get their time, and I’m sure later on they’re a lot happier” [R3.1] |
| “And I know I went to [OSP3] and I said, “Look, something’s got to be done about this. I want them stopped. I want this new memantine stopped.” And [OSP3] explained that, you know, both of them are sleep-inducing and my husband probably doesn’t need that. So that gave me confidence then to say to my doctor, “I really want that stopped. What do you think about that?”’ [FM3.1] |
| “I would probably say look, [OSP3]’s a good first contact person for anything if you think that any medication is not being given properly or they need extra medication… my first port of call really is OSP 3” [FM3.2] |
| “All we can do is try and manage it as best as we can and I guess having OSP 5 there is also useful in that respect because[OSP5]’s probably able to make changes or talk to the doctor a little bit more easily than we can, at the moment, the doctor and the nurses who are on staff at the time” [FM5.1] |
| “Oh, I just feel that if I was unsure of anything, I certainly – I think I would ask to see OSP 6 rather than the nurse, to tell you the truth… the nurses are very good, but they don’t have that capacity to do what OSP 6 – [OSP6] knows about the medication” [R1.6] |
|
| Perceived impact of OSPs by residents and family members | “Simply the fact that now that we got a pharmacist onboard, we got someone to turn to if we have a problem… we had nobody before. We had nothing. If you wanted to find out about what you’re taking, you had to wait for your doctor and he would not always explain it to you in a language that you understood” [R3.1] |
| “[OSPs] Know their [resident] needs, makes them feel a lot more comfortable – things are just there… I don’t know, it feels like a safer situation” [R1.5] |
| “It was good because [OSP1] did talk. [OSP1] did explain things… [OSP1] explained things, so that you realised that you’re not being a pain in the bum, that you’re actually – you’ve asked and there’s a reason why you’ve asked. So, yeah, [OSP1]’d made me think that I’m a little bit more – I suppose I deserve it. Yes, I suppose, deserving, because I’ve never felt, I deserved that” [R1.3] “I just felt that [OSP3] was another person who was on my side, and that [OSP3] would go into bat for me, which [OSP3] did” [FM3.2] |
| “But it’s nice to say, “Well, we’ve got a pharmacist on staff,” and people say, “Really?” But they think [the OSP]’s dispensing things and [the OSP]’s not. [The OSP]’s looking after our interests.” [R3.1] |
| “It feels comforting. It was comforting. You go away thinking, “Ah, right. Okay, if I’m ever worrying about, you know, again, I know a good port of call.”” [FM3.1] |
| “it gives you a bit of a sense of comfort that there’s someone else available that you can interact with if necessary” [FM5.1] |
| “[OSP3] is somebody that you can go to regarding the type of medications, the role of the different medications that your mum might be taking. If you’ve got any questions regarding medications or if you feel that something is needed to be added, make an appointment and talk to OSP 3 first and just get some understanding and then you can take it further if you need to, or OSP 3 can take it further” [FM3.1] |
|
| OSP impact on resident and family member empowerment | “OSP 6 actually, whenever [OSP6] does a medication review, [OSP6] goes and sits with the resident and [OSP6] talks to the resident and why you are on this medication, this medication, this medication. And [OSP6]’ll actually talk through what recommendations [OSP6]’s going to send for the doctor. So it’s about really putting the resident first and also including them in all of those decisions around their medications, and I guess empowering them again” [M6.1] |
| “So, I personally would like to be involved, if I have capacity to be, I would – or someone that has the capacity on my behalf, I would like them to be involved because it affects me, and medication is something that we take – potentially they’re taking multiple medications daily. If they’re informed, they know what they’re taking, why are they taking it, how it can benefit them, they would – I assume would feel empowered and then it would encourage them to want the best of their health care. “Oh, I should take this because it’s for my heart and it will provide this benefit.”” [OSP7] |
| “[With OSP3 being available] You feel more in control. If you have a problem, you want to feel “Oh, yeah. I can do this. This is within my grasp here.”” [FM3.1] |
| “then [OSP1] has explained, and then when [OSP1] goes, that’s when I start to think. And I think, “Well, maybe I should ask [OSP1] or I should ask that.” So the idea is growing. It’s like putting a seed in your brain. It’s growing that, you know, the more I ask and the more I talk, the more I’ll understand it” [R1.3] |
| “Empowering the residents to make some of their decisions has been helpful as well, I think. For example, one resident, really wanted to self-medicate his inhaler and so I advocated for him, and I checked his technique and I said, “Well, I think he can,” and so because of my input, he’s now able to self-medicate that and he’s a lot happier” [OSP6] |
|
