CONTRIBUTION OF A LIAISON CLINICAL PHARMACIST TO AN INPATIENT PALLIATIVE CARE UNIT

The impact on patient care of interventions made by a liaison clinical pharmacist visiting a busy inpatient palliative care unit were evalua ted using a validated six-point scoring system. Interventions made in 13% of patients could improve patient care, save money or both, but ra rely involved the drugs that are commonly used for symptom control in patients with terminal cancer. Advice to rationalize inappropriate dru g regimens (53%) was the commonest intervention, followed by warnings about drug interactions (24%) and advice about therapeutic drug monito ring (8%). The interventions were evaluated by the pharmacist, a palli ative medicine registrar and two independent doctors, confirming that the pharmacist was valid and accurate in assessing her own work. Altho ugh more than 60% of interventions could significantly improve patient care, compliance by medical and nursing staff with advice was only 55 %, reflecting possible tensions between palliative and general hospita l medicine. This survey emphasizes the role of liaison clinical pharma cists in palliative care, the need for much more critical appraisal of prescribing practices and the utility of ranking pharmacist intervent ions as a quality assurance and educational tool. In particular, provi ding palliative care for patients with advanced acquired immunodeficie ncy syndrome (AIDS) is enhanced when a pharmacist with a specialist kn owledge of AIDS therapeutics is available.