The importance of interprofessional collaboration

Case Scenario 

The nurse unit manager (NUM) of the general medicine ward in the hospital approaches you. She has noticed that her junior nursing staff are not confident with diabetes medicines. She is concerned about their medicine knowledge, methods of administration and the condition itself. She wants to collaborate in facilitated interprofessional education activities but does not know where to start, as she has not embarked on a project like this before.

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Interprofessional collaboration and interprofessional education 

Interprofessional collaboration can be defined as a “process by which different health and social care professional groups work together to positively impact care”.¹

Interprofessional collaboration occurs in healthcare and academic settings, and requires professionals to interact, communicate and cooperate with one another. Expertise and contributions are offered and appreciated in these collaborations, with the purpose being to improve patient outcomes and improve learning opportunities and experiences.²

Interprofessional collaboration involves interprofessional education, which is often defined as two or more professions learning “about, from and with each other to enable effective collaboration and improve health outcomes”.³ Interprofessional education programs and initiatives can be delivered in a variety of ways and formats, and may be embedded within university curricula, implemented by health organisations, or driven by the community. Interprofessional collaboration and education are interventions that can be applied to local health systems to help meet their needs, and to optimise services and patient outcomes. Interprofessional collaboration between healthcare professionals occurs in primary and secondary care settings. It has been shown that it has a multitude of benefits and can help alleviate the strain on our healthcare system from pressures such as staff shortages fuelled by the coronavirus pandemic, and the increasing burden of diseases due to the ageing population.³

Collaborative practice and interprofessional education are imperative in supporting professional growth, contributing to positive patient outcomes, and assisting with building and expanding practice portfolios. With the increasing and evolving scope of practice for pharmacists, opportunities for interprofessional collaboration and education will only increase.

Benefits and challenges 

There are numerous benefits to collaborative practice (see Table 1). There are also challenges in the internal and external environment which may affect the success of socialisation and collaboration between healthcare professionals. Internal factors include²: 

• our own beliefs and experiences with building interprofessional relationships 
• time and workload constraints 
• lack of confidence in building these relationships 
• lack of mutuality of respect and unaligned values. 

External factors include²: 

• lack of institutional support for collaborative practice 
• insufficient funding to support delivering programs 
• environments not conducive to interprofessional practice 
• differences in each profession’s codes of practice and guidelines. 

Challenges of interprofessional education may include logistical problems in organising or coordinating the delivery of educational programs, financial concerns (e.g. funding both the organiser’s time and the required resources) and navigating differences in vision for interprofessional education experiences.⁶

Table 1 – Examples of benefits of interprofessional collaboration, education

Opportunities for pharmacists to collaborate 

Healthcare professional roles are diverse, with differing areas of focus and speciality. Interprofessional collaboration enables pharmacists to gain a better understanding of areas of practice outside of their own and results in better health outcomes for patients.³ The Pharmaceutical Society of Australia’s Contemporary Community Pharmacy Practice: White Paper describes pharmacists as experts in medicines with a primary responsibility to ensure medicines are used safely, judiciously and effectively. 

Pharmacists should be wherever medicines are used and should collaborate with and educate those healthcare professionals involved in medicines management.⁷ The inclusion of pharmacists in multidisciplinary case conferences demonstrates the need for and importance of pharmacists being involved in interprofessional collaboration. In these, a medical practitioner works with at least two other members, with each required to provide a different kind of care or service to the patient. The purpose is to ensure that the patient’s care needs are met through a coordinated and collaborative approach, with the pharmacist contributing their expertise in medicine management to the interprofessional team.⁸

The following are examples of groups of healthcare professionals that pharmacists can collaborate with and some examples of this collaboration in action. Pharmacists should consider their current interprofessional practices but also look for other opportunities for interprofessional collaboration and education, and implement these in their practice wherever possible. 

Medical practitioners 

Medical practitioners are heavily involved in medicines management. The PSA’s Medicine Safety: Take Care report indicates that 2.5% (median estimate) of all hospital admissions in Australia are a result of medicine-related problems. This costs the system $1.4 billion annually, with 50% of this harm considered preventable.9 Pharmacists can work with medical practitioners to improve the safety, quality and efficacy of medicines use with their expertise in this area.¹⁰ Examples of this collaboration are as follows. 

Accredited pharmacists, after completing a Home Medicines Review, work closely with the referring medical practitioner regarding the potential and actual medicine-related problems that were identified. 

This collaboration aims to reduce medicine-related issues for patients, promoting both improved patient outcomes and better collaborative practice with medical practitioners.¹¹

In recent years pharmacists have been collaborating with medical practitioners in primary care with an expanded scope of practice as general practice pharmacists. General practice pharmacists provide education to the general practice (GP) team and patients, and their role may include services such as medicine reviews, clinical audits and supporting transitions of care involving medicines (including medicine reconciliation). 

It has been shown that a collaborative pharmacist-GP model of care with medicines management post-hospital discharge reduces patient readmissions and the incidence of ED presentations.¹²

In a hospital setting, pharmacists collaborate with medical practitioners daily (e.g. during ward rounds) where important interventions regarding medicines can be discussed and actioned immediately.¹³ Partnered Pharmacist Medication Charting (PPMC) is a particular area where pharmacists collaborate with medical practitioners in this setting with the aim to reduce medicine errors. 

A credentialled pharmacist’s activities, using their skills and medicines expertise, include taking early medicine histories, medicine reconciliation, collaborative decision-making at the point of admission, and pharmacist charting of pre-admission and VTE prophylaxis medicines (in partnership with medical practitioners) in acute settings.¹⁴

A large health economic report suggested an improvement to quality and safety of patient care, reduced inpatient costs and enhanced job satisfaction and interpersonal relationships of those within the team when using this model.¹⁵

Registered nurses 

Pharmacists and nurses work closely alongside each other in some settings, requiring a healthy relationship to enable interprofessional collaboration to be successful. Medicine-related responsibilities for registered nurses include administration, and managing prescribed medicine orders and medicine education (when appropriate and within their scope) to patients, their families, or carers. Pharmacists can support nurses with education and tools to promote the judicious use of medicines. 

Group education sessions delivered to nursing staff with a focus on dose calculations relevant to nursing, administration of medicines, formulation considerations and adverse reactions can reduce and prevent medicine errors in clinical settings, leading to better patient outcomes and strengthened relationships between pharmacists and nurses.¹⁷

The importance of this strengthened relationship can be demonstrated by nurses knowing they can communicate any medicine-related concern with the pharmacist to investigate prior to administration. This allows the pharmacist to discuss any medicine-related concerns with the medical practitioner and can potentially avoid medicine misadventure.¹⁶

The administration of medicines through an enteral feeding tube is an area that further demonstrates the importance of this collaboration.¹⁸ Nurses are usually responsible for administering medicines via enteral feeds. Pharmacists can support nurses to recognise when there may be issues with medicines administration and enteral feeds, by explaining different medicine formulations that may be more appropriate, suitable references for altered formulation requirements and regarding potential medicine interactions.¹⁸ A study found that an in-service education program delivered to nurses on medicines and enteral feeds by clinical pharmacists resulted in a substantial increase of nurses consulting pharmacists regarding medicines administration and increased nurses’ knowledge in this area.¹⁸

Aboriginal and Torres Strait Islander health practitioners and health workers 

Aboriginal and Torres Strait Islander health practitioners and health workers can act as cultural brokers and health system navigators to assist healthcare professionals to provide high quality, culturally safe and responsive healthcare to Aboriginal and Torres Strait Islander peoples.¹⁹

All pharmacists are required to provide culturally appropriate, responsive and safe care in their practice. Pharmacists should collaborate with Aboriginal and Torres Strait Islander health practitioners and health workers when planning and providing pharmacy services for Aboriginal and Torres Strait Islander peoples.

 As an example, pharmacists who may be new to working in a rural community or Aboriginal Health Service should contact people who are respected in the community (e.g. local Aboriginal Community Controlled Health Service, Aboriginal and Torres Strait Islander health practitioner or health worker) to learn about the local culture and how to best work and interact with patients in the community. Pharmacists can assist Aboriginal and Torres Strait Islander health practitioners or health workers by collaborating and providing education. This can be regarding medicine management services that are provided, within the health practitioner or health worker’s scope of practice, particularly as these services may occur in locations not regularly accessed by pharmacists (e.g. rural and remote communities).¹⁹

A collaborative relationship between pharmacists and Aboriginal and Torres Strait Islander health practitioners and health workers can improve access and quality of care received by Aboriginal and Torres Strait Islander patients, contributing to better health outcomes.¹⁹ Further information about the role of Aboriginal and Torres Strait Islander health practitioners and health workers is available in PSA’s Guideline for Pharmacists Supporting Aboriginal and Torres Strait Islander Peoples with Medicines Management.⁹

Occupational therapists 

Occupational therapists (OTs) assist patients to better participate in life’s everyday activities or occupations, including self-care (e.g. showering, dressing, food preparation), education, work, and leisure/social activities.²⁰

Pharmacists and OTs can collaborate regarding the safe use and handling of medicines by patients, as OTs work closely with patients in their home environments, and may assist with some of the skills required to achieve this. 

Pharmacists can educate OTs on options that can improve medicines management (e.g. different forms of dose administration aids, Pil-Bobs) and the availability of placebo devices that can be used to assess ability and use. 

Hand dexterity assessments are performed by an OT. Hand dexterity is an indicator of a patient’s ability to open original containers of medicines, use dose administration aids, and effectively use other therapeutic devices such as inhalers or injections. Pharmacists in a ward setting may identify patients who have hand dexterity concerns and liaise with the OT to help support the patient’s ability to independently manage medicines safely and effectively. The aim of this is to reduce potential medicine misadventure or issues with adherence which can be the result of impaired dexterity.^21,22

There is also the opportunity for pharmacists and OTs to collaborate within a multidisciplinary team by educating each other on their roles with the shared goal of falls prevention. Pharmacists can review medicines that increase falls risks and make recommendations, while OTs can review a patient’s environment (at home or in hospital) and recommend modifications to improve patient safety.²³

Speech pathologists 

Speech pathologists address communication or swallowing difficulties in patients.²⁴ In collaboration, speech pathologists and pharmacists can improve medicine safety among patients at risk of complications from dysphagia, including malnutrition, choking and aspiration pneumonia. Speech pathologists comprehensively assess a patient’s swallowing capability to determine the appropriateness of the oral route of administration for a medicine. They will collaborate with pharmacists to determine the most appropriate medicine formulation and administration route. 

A New Zealand interprofessional group of pharmacists and speech pathologists found that not educating the patient with a swallowing difficulty about the availability of alternative formulations or routes of administration can lead to the patient altering medicine formulations without consulting healthcare professionals, leading to reduced efficacy of the medicines. They also found many patients missed their medicines, or had patients practising unsafe swallowing strategies.²⁵ As a result the group created education packages, in consultation with people with Parkinson’s disease with a swallowing difficulty, which have the potential to empower patients with the tools needed for safe use and swallowing of medicines.²⁵

Knowledge to practice 

What can you do to start or improve your collaborative practice? 

• Start small: smaller, easily digestible ideas may build confidence and momentum personally and within your workplace. 
• Communicate with others: initiate communication, start honest conversations, ask questions with a commitment to learn about other professions. 
• Exhibit professionalism and willingness to learn: this will help to establish, build and maintain productive relationships. 
• Maintain and extend clinical knowledge: up-to-date clinical knowledge and skills are required for competent collaboration. 
• Consider all healthcare professionals: others include dietitians, physiotherapists, social workers and diabetes educators. 
• Seek guidance from an expert: others in your network who already collaborate may be able to offer additional local strategies or resources.

Planning interprofessional collaboration and education tips 

Consider co-design when planning an activity or program by having all targeted professions involved to determine suitable topics and to avoid preconceived ideas about other professions.²⁶ Consider the experience of involved practitioners to ensure a range of contributions. 

Determine the goals, learning objectives and intended outcomes and consider what practice change will ideally result from the activity. 

Consider the format and location (e.g. face to face, blended or online), and appropriateness, depending on applicable regulations and the focus. 

Be sure to create a safe, judgment-free space for your attendees; consider cultural and psychological safety and ensure inclusivity is promoted. Also consider nominating organisational workplace champions to drive and support development of future programs.^2,27

KEY POINTS 

• Interprofessional collaboration and education has numerous benefits for patients, practitioners and organisations, as well as potential challenges to consider. 
• As medicines experts, pharmacists should be wherever medicines are and have an essential role to play within the multidisciplinary team. 
• Pharmacists can work with and benefit from the input of different health practitioners in delivering patient care. 
• Tips to better collaborate include to start small, openly communicate, consider the diversity of professionals, and to seek guidance from experienced healthcare professionals where possible.

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REFERENCES

1. Reeves S, Pelone F, Harrison R, et al. Interprofessional collaboration to improve professional practice and healthcare outcomes 2017. Cochrane database of systematic reviews 2018, Issue 6. 
2. Stanley K, Stanley D. The HEIPS framework: scaffolding interprofessional education starts with health professional educators 2018;Nurse Educ Pract(34):63–71. 
3. World Health Organisation. Framework for action on interprofessional education & collaborative practice. 2020. At: http://apps.who.int/iris/bitstream/handle/10665/70185/WHO_HRH_HPN_10.3_eng.pdf;jsessionid=04B3B564CB8E713EBDD1F22A5F5DF825?sequence
4. Health Education and Training Institute (HETI). A guide to an interprofessional learning and supervision model 2013. At: www.heti.nsw.gov.au/__data/assets/pdf_file/0007/428407/A-Guide-to-an-Interprofessional-Learning-and-Supervision-Model.PDF
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8. Department of Health and Aged Care. Multidisciplinary case conferences. 2013. At: www1.health.gov.au/internet/main/publishing.nsf/Content/mbsprimarycare-caseconf-factsheet.htm
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10. Department of Health. The NSQHS Standards. At: www.safetyandquality.gov.au/standards/nsqhs-standards
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12. Freeman C, Scott I, Hemming K, et al. Reducing medical admissions and presentations into hospital through optimising medicines (REMAIN HOME): a stepped wedge, cluster randomised controlled trial. Monash University 2021. Med J Aust 2021;214(5):212–17.
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15. Safer Care Victoria. PPM Health Economic Evaluation. 2020. At: www.bettersafercare.vic.gov.au/sites/default/files/2020-12/PPMC%20Health%20Economic%20Evaluation%20Final%20Report.docx
16. Khan AN, Shoaib MH, Mir SA, et al. Practice nurses and pharmacists: a perspective on the expectation and experience of nurses for future collaboration 2014. Oman Med J;29(4):271–5. 
17. Irajpour A, Farzi S, Saghaei, M et al. Effect of interprofessional education of medication safety program on the medication error of physicians and nurses in the intensive care units. J Educ Health Promot 2019;24(8):196. 
18. Hossaini Alhashemi S, Ghorbani R, Vazin A. Improving knowledge, attitudes, and practice of nurses in medication administration through enteral feeding tubes by clinical pharmacists: a case-control study. Adv Med Educ Pract 2019;10:493–500. 
19. Pharmaceutical Society of Australia. Guideline for pharmacists supporting Aboriginal and Torres Strait Islander Peoples with medicines management 2022. At: www.psa.org.au/wp-content/uploads/2022/07/Guidelines-for-pharmacists-supporting-Aboriginal-and-Torres-Strait-Islander-peoples-with-Medicines-Management.pdf
20. Allied Health Professions Australia. Occupational therapy. 2022. At: https://ahpa.com.au/allied-health-professions/occupational-therapy/
21. Proud EL, Bilney B, Miller KJ, et al. Measuring hand dexterity in people with Parkinson’s disease: reliability of pegboard tests, 2019. Am J Occup Ther;73(4):7304205050p1–7304205050p8. 
22. Pérez-Mármol JM, García-Ríos MC, Ortega-Valdivieso MA, et al. Effectiveness of a fine motor skills rehabilitation program on upper limb disability, manual dexterity, pinch strength, range of fingers motion, performance in activities of daily living, functional independency, and general self-efficacy in hand osteoarthritis: 2016. A randomized clinical trial. J Hand Ther;30(3)262–73. 
23. The Australian Commission on Safety and Quality in Health Care. Guidebook for preventing falls and harm from falls in older people: Australian Community Care. 2009. At: www.activeandhealthy.nsw.gov.au/assets/pdf/Community_Care_Guidebook.pdf
24. Speech Pathology Australia. What is a speech pathologist? At: www.speechpathologyaustralia.org.au/SPAweb/Resources_for_the_Public/What_is_a_Speech_Pathologist/SPAweb/Resources_for_the_Pubic/What_is_a_Speech_Pathologist/What_is_a_Speech_Pathologist.aspx?hkey=7e5fb9f8-c226-4db6-934c-0c3987214d7a
25. Amer Oad M, Miles A, Lee A, et al. Medicine administration in people with Parkinson’s disease in New Zealand: an interprofessional, stakeholder-driven online survey. Dysphagia 2018;34(1):119–128. 
26. Bollen A, Harrison R, Aslani P, et al. Factors influencing interprofessional collaboration between community pharmacists and general practitioners – a systematic review. Health Soc Care Community; 27(4):E189–E212. 
27. Australasian Interprofessional Practice and Education Network (AIPPEN) IPE. Exchanging ideas about introducing interprofessional facilitation to colleagues. 2022 Jun 08. At: youtube.com/watch?v=6VjhEsSTGLI&t=834s     

SARAH ZEKARIA (she/her) BPharm(Hons), GradCertPharmPrac, MSHP is a hospital pharmacist completing postgraduate studies in health professional education, a university teaching associate for pharmacy and nursing, and an active contributor and part of interdisciplinary working groups of ANZAHPE (the Australian and New Zealand Association for Health Professional Educators).