When an aged care resident falls sick, or experiences symptoms linked to end-of-life, staff and carers work quickly to treat the cause and ease distress.
A clinician is consulted – on site or through a video-call platform. A script is issued and sent to a pharmacy. The medication is then either delivered or collected.
It’s a well-tested process that is effective and efficient, except for one thing. If the resident falls ill outside normal business hours, finding a pharmacy can be difficult, even impossible. When this happens, the resident and carers are faced with a tough choice.
They can ride it out for several hours, even days, enduring the symptoms with only over-the-counter medications and the kindness of staff to counter the pain. Or they can summon an ambulance and request a transfer to the nearest hospital emergency department, again quite possibly enduring a long wait for treatment, only this time in unfamiliar surroundings.
Recognising this dilemma, NWMPHN partnered with the North and West Metropolitan Region Palliative Care Consortium (NWMRPCC) to trial a solution.
It’s known as an ‘imprest’ system, and means that certain prescription medicines are held inside a securely locked safe on the premises of the aged care home.
When a resident falls ill outside business hours, clinician consultation proceeds as usual. If the clinician determines that medication is required, but a hospital transfer isn’t, a script can be sent direct to the home. Onsite nursing staff are then authorised to access the imprest safe and administer the treatment.
Some aged care homes already operate imprest systems. For those that do not, NWMPHN opted to test whether funding for installation, initial stock purchase and training might be useful.
To test this process, NWMPHN invited expressions of interest from aged care homes. This covered the cost of the initial stock of medications, the purchase and installation of a secure safe, and education and training for staff.
The grants were available to homes in the NWMRPCC catchment, which is slightly different to that of NWMPHN. As a result, nine successful applicants were based in the NWMPHN catchment, with the remaining one falling under the remit of Eastern Melbourne Primary Health Network.
All 10 completed staff training, including developing and implementing appropriate procedures and registers.
The effectiveness of the imprest system was assessed over five months. During that time, medications were prescribed and dispensed 99 times – a number that illustrates the need and utility of the project.
The most common issue treated was respiratory distress. Other conditions included urinary tract infections, nausea, wound infection, generalised pain and symptoms associated with end-of-life.
Of the 99 residents treated, only one required a subsequent hospital transfer.
“The imprest pilot has been a clear success,” says NWMPHN’s Executive Director of Health Systems Integration Bianca Bell.
“It played a strong role in easing distress and improving access to care for some of the most at-risk people in our community. Feedback from the staff also shows that it reduced their stress as well.”
NWMPHN is currently assessing the feasibility of offering another round of grants so that more aged care homes can implement an imprest system.
Some operators, however, aren’t waiting around. One of the homes involved in the pilot was owned by a company that oversees multiple homes. Following the success of the trial, the company has pledged to install imprest systems in all its facilities.
Note: on 19 November 2024, NWMPHN opened up another round of grants for RACHs to establish an imprest system. Applications are open until 10 January, 2025. Click here to access the EOI.
