CONSULTANT PHARMACY IN A LONG-TERM CARE SETTING

AN AGING POPULATION AND changes in the provision of health care are fueling opportunities for consultant pharmacists. Consultant pharmacists are providing daily pharmaceutical care to our country?s geriatric and special needs populations. If you are looking for a practice that requires routine use of clinical, regulatory, teaching, drug information, and even customer service skills, consider consultant pharmacy.

I have been a consultant pharmacist for 10 years. My interest was fueled by a professor?s enthusiastic approach in presenting patient cases from his consultant practice to the class. He displayed a delicate balance of clinical skills tempered with regulatory issues required in managing patients. My practice of consultant pharmacy presents with fascinating daily challenges. Through routine review of resident medication regimens, lab work, subjective/objective clinical data, and, at times, resident interviews, I am able to directly impact the care of an elderly or special needs individual. Most days involve traveling to a different workplace at either a skilled nursing, assisted living, or mental health/mental retardation facility. This is a result of the Omnibus Reconciliation Act (OBRA) guidelines requiring that a resident?s medication regimen be reviewed monthly by a consultant pharmacist. OBRA guidelines mandate that therapeutic outcomes complement federal requirements in provision of care to residents.

Attending physicians are required to review residents in a skilled nursing facility every 60 days. A great deal of change occurs between visits. Changes may occur in the resident?s health, medication, or laboratory values, which necessitate review and followup. This will influence the consultant pharmacist?s recommendation in areas such as drug selection, dosing, administration, related labs, objective/subjective monitoring parameters (as in psychiatric meds), and even consults from practitioners from other disciplines.

Each facility setting presents its own special issues. Residents in skilled facilities are increasing their ?acute care? orientation, requiring intensified medication management skills. This may be contrasted to an assisted living resident that presents similarly to a patient in the retail pharmacy environment. Many assisted living residents are able to care for themselves and self-medicate. Resident medication regimens are routinely reviewed considering potential issues with compliance, medication choices, drug interactions, drug-disease interactions, and adverse reactions.

I routinely participate in quality assurance committees that have representatives from different disciplines within a facility. These disciplines include the medical director, administrator, directors of nursing, social services, dietary, accounting, and facility services. At these meetings, policies regarding care of residents and operation of the home are discussed and decided upon.

I often meet with many of the aforementioned in other meetings. There, we develop policy and procedures for medication management. Policies developed range from cost-efficient medication use (such as therapeutic interchange) to assuring appropriate laboratory testing is being performed.

Another routine committee involves psychoactive medication management. It is a multidisciplinary team that includes nurses, nurses? aides, and sometimes the facility psychiatrist. Patient cases are individually reviewed, considering input from all disciplines, resulting in recommendations made for patient care to be approved by the attending physician and implemented by the staff.

Drug information is also provided to the staff and physicians. This may involve literature searches (eg, MEDLINE) or obtaining information from other clinicians (eg, hematologists) or colleagues who may offer their clinical expertise regarding a particular specialty. From time to time, the opportunity may present itself to participate in developing or designing a research project. The growing field of geriatric medicine is always looking for new information and guidelines in treating the elderly.

Performance of medication administration audits, chart documentation, and medication storage audit are required to be performed by the consultant pharmacist. On any given day, I might find myself performing a staff/family education session with topics ranging from disease state management to regulatory issues.

Consultant pharmacists also benefit from membership in the American Society of Consultant Pharmacists (ASCP). Through this professional organization, accreditation is available as a Certified Geriatric Pharmacist and the recognition as fellow. ASCP also offers clinical trainee programs allowing the consultant pharmacist to receive intensified training in specific disease states that present in daily practice. For more information regarding the practice of consultant pharmacy, visit www.ASCP.com.

I am fortunate to be a part of a profession that directly impacts the care of our elderly and special needs populations. I believe one of life?s greatest gifts is the ability to positively impact the world through the individuals that surround us in our daily life. As a consultant pharmacist, this ?gift? has the potential of being fulfilled every day.

Mr. Czechowski is a consultant pharmacist with CCRx in Harrisburg, Pa.