The Role of the Pharmacist
Pharmacotherapy is key component of palliative care and pharmacists trained in this specialty also play critical roles in communicating with patients and their families, ensuring comfort, and providing education and emotional support. Pharmacists employ their knowledge of regulatory requirements to facilitate access to needed pain medications, avoid interruptions in care, and ensure safe storage and disposal of unused medications. Pharmacists can also use their medication expertise to avoid adverse drug events in a patient population that is characterized by multiple co-morbidities, including heart failure, chronic obstructive pulmonary disease, HIV infection, and neurological disease.
Examples of Transformational Change in Pharmacy Practice
Below are highlights of the important role pharmacists play in improving palliative and end-of-life care:
Hospice Care: A descriptive study of 87 drug-related problems identified by pharmacists with specialty training in hospice care found that among the clinical interventions recommended by pharmacists 84% were accepted by the prescriber and 85% were described as helpful in achieving the desired therapeutic goal. See Lee J and McPherson ML. Outcomes of recommendations by hospice pharmacists. Am J Health-Syst Pharm. 2006; 63:2235-9.
Geriatric Care: A randomized controlled trial evaluated the extent to which clinical pharmacists’ consultation lead to improvement in appropriate drug prescribing for geriatric patients. Pharmacists reviewed hospital records and drug regimens to assess the appropriateness of prescribing and consulted with patients to reinforce physician instructions, enhance patient’s knowledge and motivation, and provide resources to facilitate adherence. 
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Pharmacist consultation resulted in a significant reduction in the number of patients with a drug-related problem (p=0.05), especially less than optimal medication use or medication with no indication (p=0.01) and less than optimal dosage (p=0.05). There was a significant increase in the overall appropriateness of prescribing (p=0.01).
See Lipton HL, Bero LA, Bird JA, et al. The impact of clinical pharmacists’ consultations on physicians’ geriatric drug prescribing: A randomized controlled trial. Med Care. 1992; 30(7):646-58.
Palliative Care: In an evaluation of 130 interventions provided to 25 patients by community pharmacists trained in palliative pharmaceutical care, an interdisciplinary expert panel found that 81% of the interventions were likely to be beneficial. See Needham D. Evaluation of the effectiveness of UK community pharmacists’ interventions in community palliative care. Palliat Med. 2002; 16:219-25.
Relevant ASHP Best Practices
Other ASHP Resources