Embedded on‐site aged care pharmacists in Australia: Insights from early adopters of a new workforce model

To explore the roles of early adopters of Australia's embedded on‐site pharmacist model in supporting quality use of medications in residential aged care facilities (RACFs).


| INTRODUCTION
2][3] These new workforce models include greater multidisciplinary collaboration, including integration of pharmacists and allied healthcare professionals into the RACF care team. 4he Australian Government announced AU$345.7 million for national roll-out of embedded onsite pharmacists in Government-funded RACFs from 2023 to 2027. 5,6This new role is distinct from the current model of pharmacy services in RACFs.The Australian Government has funded collaborative medication reviews (known as residential medication management reviews) since 1997; however, only 22% of residents receive a review within 3 months of admission. 7esidential medication management reviews are currently provided by consultant pharmacists 8 and general medical practitioners (GPs) external to the aged care provider organisation.The new embedded on-site pharmacist role is also distinct from medication dispensing and supply services (e.g.packing dose administration aids) provided by off-site community pharmacies. 9he new embedded on-site pharmacist role is partly based on an Australian pilot study that demonstrated that an on-site pharmacist improved medication administration practices by reducing inappropriate dosage form modifications (24% pre vs. 0% post) and mean time spent on medication rounds (4.8 pre vs. 3.2 min/per resident/round post). 10The role is also based on emerging Australian and international evidence for activities including medication reconciliation 11 ; antimicrobial, psychotropic and analgesic stewardship 12,13 ; regimen simplification 14 ; and vaccination. 15Evidence from three pilot studies in the UK showed an average saving of £153 per resident due to medication optimisation, prevention of avoidable hospitalisations and reduced medicine wastage. 2 There is an opportunity to define the role for embedded on-site pharmacists in RACFs.A clear role description has been recognised as a facilitator for the successful integration of pharmacists in other settings, such as primary care teams. 16Individual resident medication review is anticipated to be a major component, 17 but the level of pharmacist involvement in other system-level interventions to optimise medication use, such as audit and feedback, developing or revising guidelines and clinical governance meetings, 18,19 needs to be defined.System-level roles for pharmacists may involve pharmacists acting as knowledge brokers. 20nowledge brokers are individuals or groups that act as intermediaries and facilitate the translation of 'knowledge' from those who create the knowledge (e.g.guideline developers) to those who use the knowledge (e.g.health-care professionals and aged care providers). 21,22he objective of this study was to explore the roles that early adopters of Australia's embedded on-site pharmacist model have in supporting quality use of medication in RACFs.

| Study design
We conducted qualitative semistructured interviews with early adopters of the embedded on-site pharmacist role in Australian RACFs, or pharmacists working in a role that shared aspects of an embedded on-site role.Interviews were conducted as part of the Evidence-based Medication knowledge Brokers in Residential Aged CarE (EMBRACE) trial, which aims to investigate the role of embedded onsite pharmacists acting as knowledge brokers to facilitate implementation of guidelines into practice.This study was approved by the University of Queensland Human Research Ethics Committee (2022/HE001147), and conducted and reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) Statement. 23

| Study setting and sampling
Participants were identified via the professional contacts of the investigators using purposive and snowball sampling (i.e.participants were asked whether they knew of other eligible pharmacists that the investigator team could contact).Purposive sampling was used to identify embedded on-site pharmacists working in different Australian

Practice Impact
Being on-site and embedded within the interprofessional team provided pharmacists with greater opportunity to contribute to collaborative resident-centred care and system-level clinical governance and quality improvement processes related to quality use of medication.The findings will be useful in defining the model for widespread implementation of embedded on-site aged care pharmacists.
states and territories, and in public, private and independent not-for-profit aged care provider organisations.Snowball sampling was used to maximise the sample size given the small number of pharmacists currently embedded on-site in RACFs in advance of the national rollout in 2023.
Eligibility criteria for pharmacists included having current or prior experience as an embedded on-site pharmacist in an Australian residential care setting.Pharmacists who conducted residential medication management reviews and provided quality use of medication (QUM) services were also eligible to participate if they provided additional enhanced services consistent with proposed roles of an on-site aged care pharmacist.Enhanced services needed to be beyond the traditional scope of medication review and/or delivery of quality use of medication education sessions to staff at the facility.Enhanced services included, but were not limited to, participation in clinical governance meetings (e.g.medication advisory committees), involvement in delivery of medication stewardship programs (e.g.antimicrobial stewardship), conducting drug use evaluations and developing resources related to safe and effective use of medication.In Australia, quality use of medication services focusses on improving practices and procedures relating to medication use. 24Quality use of medication services, including education, training and clinical governance, are facility-focussed and traditionally delivered by a consultant pharmacist or a community pharmacy that supplies medication for the RACF. 24articipants were provided an AUD $50 (USD $32) gift voucher as an acknowledgement of their time and participation.

| Data collection
Interviews were conducted by Author Cross or Author La Caze using a semistructured discussion guide developed by the investigators (Appendix S1).Authors Cross and La Caze are pharmacists and experienced qualitative researchers.
Written informed consent was obtained from all participants prior to interviews.All interviews were conducted via Zoom, audio-recorded and transcribed verbatim.The investigators (Author Cross or Author La Caze) also wrote notes during and immediately after interviews to inform data analysis.Participants were offered the opportunity to review the transcripts for accuracy.
Given that being an embedded on-site pharmacist is an emerging role, we aimed for an initial analysis sample of 10 interviews. 25After 10 interviews, further interviews were conducted until the point of data saturation when no new major themes emerged.The interviews were conducted in July and August 2022.

| Data analysis
Thematic analysis was used to analyse the data. 26Data management was facilitated using NVivo Pro (version 20.0; QSR, International Pty Ltd).We used a predominately inductive approach to analysis.Two investigators (Author Cross and Author La Caze) read the transcripts and independently coded the data.The two investigators coded an initial subset of five interviews and then met to discuss, compare findings and refine emergent themes.The remaining interviews were then coded, before being discussed and refined by the wider investigator team.
We also conducted a secondary deductive analysis of roles of embedded on-site pharmacists using a framework based on the three core roles of a knowledge broker from the literature; knowledge manager, linkage agent and capacity builder. 21,22This was part of informing the design of the EMBRACE trial intervention, where pharmacists will be acting as system-level knowledge brokers to facilitate implementation of a new Clinical Practice Guideline for the Appropriate Use of Psychotropic Medications in People Living with Dementia and in Residential Aged Care into practice. 27

| RESULTS
Fifteen early adopters of the embedded on-site pharmacist model participated, including eight with direct experience as embedded on-site pharmacists and seven who provided one or more enhanced services consistent with that of an on-site aged care pharmacist and beyond the traditional medication review/quality use of medication roles (Table 1).Participants were mostly female (n = 12), were from four states and territories of Australia and worked with a range of public (n = 1), private (n = 5) and not-for-profit provider organisations (n = 4), or more than one type of provider (n = 5).The median interview length was 35 min (range 18-53 min).

| Part 1: Inductive analyses
Three main themes were identified including: roles and benefits of embedded on-site aged care pharmacists; factors associated with success in fulfilling an embedded on-site role; and challenges associated with working as an embedded on-site aged care pharmacist. 3.1.1| Roles and benefits of embedded on-site aged care pharmacists Pharmacists described their roles as 'medicationmanagement within the aged care facility …everything medication-related I try and have a part in' (Pharmacist 2).These roles, and the subsequent benefits of having an embedded on-site aged care pharmacist, largely fell under resident-and system-level interventions (see Table 2 for additional supporting quotes).

Resident-level interventions: Collaborative outcome-focussed resident-centred care
Pharmacists described resident-level interventions as a core component of their role, including medication review, medication reconciliation at transitions of care, ward-rounds and case-conferencing.Embedded on-site pharmacists were able to 'focus on residents' (Pharmacist 11) and had greater ability to provide timely input into medication management decision-making.Embedded pharmacists described being able to 'act on things a bit sooner' (Pharmacist 15) and provide timely input into decisions following key events such as admission, hospital discharge, respite, falls or ADRs.Participants saw this as a key difference between the embedded on-site role and the more limited opportunities provided within existing residential medication management reviews roles.
Achieving better medication-related outcomes for residents was supported by enhanced relationships with residents and their families.Embedded pharmacists were able to spend more time communicating with residents and their family than possible within the current model of care.This included being better positioned to be 'an advocate for the residents' (Pharmacist 6) and being able to identify and support the resident's evolving goals of care.
Enhanced relationships with the interdisciplinary team allowed pharmacists to be more involved in collaborative care, including proactive rather than reactive decision making (e.g.relating to preventing falls), which resulted in 'better outcome [s] for our resident[s]' (Pharmacist 15).

System-level interventions: Contribute to clinical governance and quality improvement processes
Pharmacists described system-level interventions as an important component of their role which involved 'working with all levels of staff in the aged care facilities, from management to the corporate groups, to the manager at each facility, the RNs [registered nurses], the PCAs [personal care assistants], and the medical staff there' (Pharmacist 3).Embedded on-site pharmacists described greater capacity to actively contribute to a wide range of clinical governance and quality improvement initiatives, compared to traditional medication review and quality use of medication contracted pharmacists.
Embedded on-site pharmacists were able to enhance medication management capacity of staff through T A B L E 2 Supporting quotes for roles and benefits of an embedded on-site aged care pharmacist.

Timely input and being able to directly follow-up medication-related problems
The real key about being embedded there is, one for me is, I think, the frequency of intervention Enhanced relationship with the interdisciplinary care team I think the multidisciplinary approach, too; so, having the meetings with physios, which is something I never would have done pre-you know, as a community pharmacist.That's been really good, to have their side of things (Pharmacist 2) And there is more communication with staff because I'm part of the team.
And there is also more case conferencing with the GPs and their family or the EPOA [enduring power of attorney] for the resident (Pharmacist 11)

System-level interventions: Contribute clinical governance and quality improvement processes related to medication management
Enhance medication management capacity of staff through education and support education and support.Embedded on-site pharmacists were 'on the ground for day-to-day enquires' (Pharmacist 8) and had the opportunity to provide tailored education and support to a broad range of care staff.Pharmacists provided advice on best-practice (e.g.crushable medications), encouraged use of evidence-based tools, invited staff to ask questions and recognised if errors were being made during medication administration.Embedded on-site pharmacists were also able to enhance medication management capacity of the organisation by developing and supporting medication-related policies and procedures.Pharmacists were able to contribute their expertise to aid decision-making regarding medicine policy and procedures to ensure compliance with regulation and accreditation standards.Some of the embedded pharmacists took leadership roles within these initiatives: I look after governance.I chair the Medication Advisory Committee and Antimicrobial Stewardship Committee.Yeah, and I look after policies too regarding medications.I review regularly policies including diabetes medication management, vaccination policy. ( By taking on these roles within the facility and organisation, embedded on-site pharmacists were able to reduce the load on other staff within RACFs.Key examples were related to reducing the reporting burden (e.g.National Mandatory Quality Indicators reporting), assisting with accreditation, reducing medication administration times and documentation required to comply with guidelines and best practice.Pharmacists also discussed being able to streamline processes for GPs and the community pharmacy providing medication services to the facility: It's just a time reduction by having a pharmacist that has extensive knowledge about psychotropic medications, the whole systems of monitoring them and keeping track of them can be simplified.(Pharmacist 8) 3.1.2| Factors associated with success While most of the participants identified similar roles, some participants were able to describe a higher level of success in the role.Successful embedded pharmacists provided concrete examples of (1) how they were embedded within multiple levels of the aged care organisation, including multidisciplinary teams, and (2) how by being embedded they were able to have a greater impact within both resident-level and system-level interventions.This theme identified the key factors that appeared to promote the success of these participants in their role (see Table 3 for additional supporting quotes).
Personal capabilities and approach of the embedded on-site pharmacist Successful embedded on-site pharmacists were effective collaborators within interprofessional teams.These pharmacists worked effectively in teams across multiple levels of the aged care organisation: care teams, quality improvement teams and clinical governance teams.These pharmacists described the need to 'be visible' within the facility and proactive in communicating about their role to ensure all stakeholders understood 'what I can do and how they can utilise me' (Pharmacist 2).They built 'really good collaborative relationships' (Pharmacist 10) with stakeholders, understanding their drivers and challenges, and 'nurturing positive relationships and open communication channels' (Pharmacist 9) with a wide variety of health professionals, carers, residents and senior staff.Less successful outcomes were described by participants who were not effectively embedded within the RACF and tended to describe their role as advisors to the interprofessional team who then had ultimate responsibility for resident outcomes, as opposed to a member of the interprofessional team with shared responsibility for resident outcomes.Successful embedded on-site pharmacists described the importance of embracing and driving the on-site role so that it evolved to meet the needs of the aged care organisation and all the stakeholders involved in medication management.These pharmacists were self-motivating practitioners, who initially drew on their clinical knowledge and experience of the aged care setting from conducting medication reviews.Pharmacists spoke of the need to 'seize the opportunity' (Pharmacist 4) and 'take an active role in anything [medication-related] that came up' (Pharmacist 12).Pharmacists spoke of adapting learnings from different RACFs or practice settings (e.g.hospital and research), sharing knowledge between aged care pharmacists at different sites and implementing national quality improvement projects and stewardship programs.Many described an expansion of hours and responsibilities over time.

Organisational culture and broader sector-wide system factors
Organisational culture in relation to medication management and the role of the embedded on-site pharmacist was an important factor for success.In the absence of significant organisational support, it would not have been possible for the pharmacists to develop and extend their role.
In some cases, the organisations proactively identified the need for the role, recruited and then supported the pharmacist in their role.With this level of organisational support, an early career pharmacist was able to achieve positive outcomes early in their role: So, it was a bit daunting coming into this role…but it's been really good because I have a lot of nurses come up to me asking for help… they've really, really included me into this.
(Pharmacist 15) Most participants also recognised the benefit of sectorwide system factors.These factors worked at different levels to support the pharmacist in their role.This included regulatory changes, Aged Care Quality and Safety Commission recommendations and media discussion regarding medications as well as being 'backed' by geriatricians and other specialists.13) in order to develop the skills to work in this setting.Some of the medication review pharmacists described little desire to transition into on-site roles due to a perceived lack of flexibility, possible poor remuneration or an inability to take on additional workload.
A second set of challenges relates to determining an appropriate service model so that the embedded on-site pharmacist is appropriately supported and can contribute to both resident-level care and system-level medication T A B L E 3 Supporting quotes for factors associated with success for an embedded on-site aged care pharmacist.

Personal capabilities and approach of the embedded pharmacist
Effective collaborators within interprofessional teams I think that you really almost need to walk in everyone's shoes to be able to work as a team, to be aware of the constraints that nursing staff, that medical staff, that residents, patients or whatever you like to call them, and their families have and their knowledge base.So, I think for collaboration, we need to have that understanding of where they're all coming from and their standard of health literacy so that we can speak to them in a meaningful way (Pharmacist 3) I made sure I was in the same place every week wearing exactly the same clothes.Wearing the same badge.I would make sure that I was completely recognisable.These homes are quite big -the largest one was 120 beds -and there's no way that I'd know all the staff each week, so I made sure that I looked exactly the same.management.Some pharmacists found their system-level role was limited because 'changes happen above [the facility] level' and quality improvement initiatives required changes at a regional or corporate banner level before they could be implemented.Others had a model of service that focussed on providing system-level clinical governance and quality assurance roles in addition to residential medication management reviews services to a large number of facilities and had less opportunity to engage in resident-level collaborative care.Some pharmacists discussed the benefits of accountability to the RACF as important to ensure buy-in from RACF stakeholder.Others described the conflict that existed when the pharmacist had accountabilities to different stakeholders due to employment arrangements (e.g. both community pharmacy and RACF), 'I had two bosses who weren't seeing eye-to-eye' (Pharmacist 12).Additional external factors largely out of control of the pharmacists were also discussed.These included factors that impacted the pharmacist's ability make best practice recommendations including the COVID-19 pandemic, information technology (IT) issues, RACF staff shortages and lack of funding for non-pharmacological management.The nature of RACFs, where most prescribers, specifically GPs, are not on-site, also made communicating and engaging with prescribers challenging.Large numbers of GPs serving one facility, short GP visits and lack of GP engagement with Medication Advisory Committees made collaborative care difficult in some cases despite best efforts by the pharmacist: 'That's my real challenge at the moment just trying to get hold of doctors' (Pharmacist 15).

| Part 2: Deductive analyses using knowledge broker framework
Deductive analyses demonstrated that roles of an embedded on-site aged care pharmacist, specifically system-level roles, were consistent with roles of a knowledge broker including being a knowledge manager, linkage agent and capacity builder (Table 5).
T A B L E 4 Supporting quotes for challenges associated with working as an embedded on-site aged care pharmacist.

Workforce shortages and readiness of the pharmacist workforce
There is a huge opportunity to have greater involvement, but yeah, I'm not entirely sure how to get there, how to boost my involvement and my workload is a big factor in that at the moment as well (Pharmacist 1) I think it's quite isolating, and I think the person doing it has got to have fair amount of experience with it.They're certainly going to need mentoring.The hospital pharmacist could do it, but they have to change from being acute providers to chronic providers, and there's quite a transition of care with it.So, it's not something that a person just coming out and freshly accredited would be able to do, so they're definitely going to need mentoring.And then they're going to need systems to do it (Pharmacist 4)

Determining an appropriate service model
As far as me having a role more than I already do at the public facility, they tend to have a lot of all the quality measures controlled by different staff already.I feel like there wouldn't be a great deal.You're kind of following someone else's orders already (Pharmacist 1) Most of our sites, if they're under a corporate banner, changes happen above that level.So, it goes to the clinical governance meeting, and that's when policy would change and it'd be fed down.
So probably an example is I recently was involved in the commission's pilot around to dip or not to dip, and we did that at the site level.I came across at one of our sites that their policy stated that if someone had a fall, they have to do a dipstick.While I could tell the staff that we need more than just having a fall to do a dipstick, they still had to obey by their policy because that's their thing.So that actually went up to the clinical governance meeting and we got the policy changed at the top for all the sites (Pharmacist 14) External factors I think there's a real problem with our pharmacists at the moment, particularly with COVID, getting access to a lot of this information, and sometimes, which really saddens me, that pharmacists haven't been able to go into a facility because they're not considered to be essential (Pharmacist 3) And until we get more staff, it is ridiculous to say, "Stop the medications," because they haven't got the staff, [to] do the one-to-ones with them, we need more diversional therapists.And we need the families coming in to take a bit more ownership again, and to take them out for a coffee or to take them out for a walk.And the nursing staff are beside themselves.They're short-staffed.They're working huge hours.And they really can't do the non-drug activities that we try and set up (Pharmacist 4) This was the first exploration of the roles and benefits, factors associated with success and challenges of Australia's new embedded on-site aged care pharmacist workforce model.This study highlighted the value of integrated resident-and system-level roles, with both pharmacist and organisational factors determinants of successful implementation and expansion of the role.Embedded on-site pharmacists perceived a greater opportunity to deliver resident-and system-level interventions.Resident-level interventions were often extensions of residential medication management review roles, but with timelier involvement and follow-up and enhanced relationships with residents, family and the interdisciplinary care team.Being on-site and embedded within the interprofessional team provided pharmacists with an opportunity to accept greater responsibility for resident outcomes.System-level roles were consistent with that of a knowledge broker, including acting as a knowledge manager, linkage agent and capacity builder. 21,22Our results parallel findings from an Australian pilot study which described major activities of on-site pharmacists as medication management (i.e.resident-level), communication (i.e.linkage agent), education and quality improvement (i.e.capacity builder) and administration including policies and procedures (i.e.knowledge manager). 19Our findings also reflected the key factors that pharmacists felt were important to prepare them to work on-site in residential aged care, namely resident-level skills, communication and team work, and system-level experience. 28he pharmacists described how roles evolved to reflect the needs and expectations of the RACF and stakeholders.This is consistent with evolution of pharmacist roles in general practice clinics. 29The diverse geographical and organisation structures of aged care provider organisations was also recognised.Thus, moving forward, it may be prudent to define a model or framework within which embedded on-site pharmacists can practice, rather than a strict 'national role description'. 30A B L E 5 Deductive coding of pharmacists acting as knowledge brokers including activities undertaken and exemplar quotes.There's been many times where I've run little information sessions for the residents, and that seemed to be well-received (Pharmacist 13) And then being there more regularly, you can do formal -once a month, we do a formal education session with the nurses, but that kind of on-the-spot education as things go wrong or when there's questions that pop up straight away (Pharmacist 5) I used to do audits on medication administration times so that we could rationalise it to best fit the nursing staff logistics (Pharmacist 7)

Examples of activities undertaken by pharmacist
Personal capability and approach of the pharmacist were perceived as integral to successful implementation.Experienced self-motivated pharmacists embraced and drove the role.Being highly visible while on-site was important but did not ensure success.The development of professional relationships and organisational support were perceived as key to becoming truly embedded.These factors are consistent with barriers and facilitators of pharmacists integrating into multidisciplinary ward teams 30 and primary care teams, 16 as well as key factors identified as important in planning for successful roll-out of the on-site pharmacist model. 29On-site pharmacists also described how they were able to facilitate interprofessional communication, which has been identified as an enabler for optimisation of medication use for people living with dementia. 31Direct employment and accountability of the pharmacist to the aged care provider organisation facilitated the process of becoming embedded, allowing for less experienced pharmacists to achieve early success, but this arrangement did not appear to be essential.
Participants perceived lack of readiness among the broader pharmacist workforce.Participants did not feel the role was appropriate for new graduates.This was because the participants perceived they needed to draw on their prior practice experience (e.g.conducting medication reviews).Familiarity with the aged care setting, as well as direct or indirect resident-level and system-level experience, has been reported as key factors influencing preparedness of the wider pharmacist workforce to work in aged care. 28revious experience working in collaborative settings and advanced training/credentials are known facilitators of integrating into the primary care setting. 16Some participants who presently conducted residential medication management reviews did not want to transition into an embedded on-site role.This was due to concerns related to remuneration, career progression and lack of flexibility.It was unclear whether recent graduates would share the same concerns.Anecdotal evidence suggests many recent graduates are interested in aged care pharmacy.However, if the on-site pharmacist model is unable to address these concerns among experienced pharmacists, then strategies should be put in place to mitigate against the potential loss of their knowledge and skills from the workforce (e.g. through adopting mentoring and training roles).

| Strengths and limitations
A key strength of this study was the diverse sample of pharmacists from four states and territories working in a range of public, private and independent not-for-profit aged care provider organisations.This comprehensive exploration was the first to explore roles of pharmacists practicing outside a clinical trial framework.A limitation of this study was that the findings may not be generalisable to other countries.Most early adopters of the embedded on-site pharmacist model were experienced aged care pharmacists.It is not clear whether pharmacists who work as embedded on-site pharmacists as part of the national rollout will have the same level of initial skills and experience.Participants may have described roles reflective of their professional interest and expertise.It was unclear to what extent this coincided with roles that residents, prescribers, nurses, community pharmacists and aged care provider organisations desired.For this reason, there is also a need to consider the perspectives of other stakeholders.

| CONCLUSIONS
This study is the most comprehensive exploration of the emerging embedded on-site aged care pharmacist workforce model.It highlights the roles of embedded on-site aged care pharmacists, and the benefits and need for integrated resident-and system-level interventions.The findings will be useful to pharmacists, RACF staff, aged care provider organisations, policymakers and governments in defining the model for widespread implementation of embedded on-site aged care pharmacists.It highlights the pharmacist and organisational challenges and factors for success, which can be used to direct efforts to prepare the workforce and RACFs, including the development of guidelines and materials to facilitate the roll-out.

ACKNO WLE DGE MENTS
The authors would like to acknowledge the efforts of the full EMBRACE investigator team in conceptualisation and funding acquisition for the EMBRACE study.Open access publishing facilitated by Monash University, as part of the Wiley -Monash University agreement via the Council of Australian University Librarians.

FUNDING INFORMATION
AJC is supported by an NHMRC Emerging Leadership 1 Grant (APP2009633), and this project formed part of a larger project funded by the Medical Research Future Fund (GA187306).

CONFLICT OF INTEREST STATEMENT
Abbreviations: FTE, full time equivalent; QUM, quality use of medication; RACF, residential aged care facility; RMMR, residential medication management review.
. You can review and talk about and monitor a single resident three or four times in a week if you had to, so particularly if there's been changes to medications.You can follow up by being on-site (Pharmacist 5) Having somebody on site, every new admission can be assessed depending on what hours you're associating to your embedded pharmacist.But within a week of a new admission or within a week of transferring back from a hospital, within a week of having a fall, you can have that immediate pharmacist review (Pharmacist 8) Enhanced relationship with residents and family And then building rapport with residents and families, also really important.You can find out a lot more information if you're familiar with the person, and they'll be able to tell you things that you might not find in some clinical notes or something like that.And if they know there's someone that's sort of looking out for their medications, they might bring up medication-related things earlier and faster (Pharmacist 5) And again, you became an advocate for the residents, for the doctors, so can you let me know if anything else changes or check on their blood pressure.And for families as well, you become part of that.They see you often, and they can rely on you to be an advocate for them.And when you just become then part of everybody's team because you're visible on the site, you can have those face-to-face discussions that are just a lot more challenging via phone or fax (Pharmacist 6) So, the role has evolved and developed… So, I started off as part-time 0.6 [full time equivalent] and then increased quite quickly to a full-time role because, yeah, the need was so great.And I think they probably didn't realise the impact a pharmacist could make in so many other areas too, which is really positive for us (Pharmacist 10) So, you really have to put yourself out there and lean in and go above and beyond and be creative and all of that (Pharmacist 9) Sometimes it just flows over from what I'm doing for the public system in helping out the private organisation to decide what they want to do (Pharmacist 1) So far, I've only been here for two months, but I've built a good relationship with my colleagues alreadyand they can come to me whenever they need any suggestions and things like that.So yeah, I think so.Whereas it might be a bit different if you were working externally.They might feel like they don't want to bother you as much.Whereas with me, I'm a colleague.They can come to me any time they want.So, they feel a bit more comfortable just messaging me, emailing me (Pharmacist 15) I think psychotropics is a priority of the aged care quality and safety commission.I think all of the commission findings have driven that.And the lay media and consumers have really caught on it, so it's got all those extra drivers over and above, say, antimicrobials or opioids (Pharmacist 9) So, we've done education for GPs, but we've actually had the geriatricians do it as well with pretty good response from the GPs, yeah, around that.So, they respond to us really well on a patient-bypatient case.I think just giving up their time to attend education, it is much better coming from a geriatrician (Pharmacist 14) JSB has received grant funding or consulting funds from the National Health and Medical Research Council (NHMRC), Medical Research Future Fund (MRFF), Victorian Government Department of Health and Human Services, Dementia Australia Research Foundation, Yulgilbar Foundation, Aged Care Quality and Safety Commission, Dementia Centre for Research Collaboration, Pharmaceutical Society of Australia, GlaxoSmithKline Supported Studies Program, Amgen, and several aged-care provider organisations unrelated to this work.All grants and consulting funds were paid to the employing institution.AJC, MS and ALC have no conflicts of interest declared.