Consultant Pharmacy in Long-term Care Brings Challenges

Dr. Lawrence is director of Clinical Pharmacy Services at Phoebe Services Pharmacy in Allentown, Pennsylvania, and is preceptor for the long-term care elective rotation at the University of Pittsburgh and Wilkes University.

I know what you are probablythinking, ?nursing homes?notmuch of a clinical challenge.?I know, because I thought thesame thing when I was at a careercrossroads 9 years ago, stuck betweenthe choices of my staff/clinical positionin a teaching hospital or makingthe leap to a consultant pharmacistposition in long-term care (LTC). Itook a chance, made the change, andhave had the 9 most challenging andrewarding years of my career. Thefollowing is a brief look at the role ofconsultant pharmacists.

The primary responsibilityof theconsultant pharmacistis the medicationregimen review.Omnibus ReconciliationAct guidelinesrequire all residentsof skilled nursing facilities (SNFs)to have their medication regimenreviewed by a consultant pharmacistat least once per month. Centersfor Medicare & Medicaid Services(CMS) guidelines and requirementsfor medication use in SNFs are extensiveand beyond the scope of thisarticle; however, the consultant candivide a medication regimen reviewinto 3 components.

1. Clinical Review. This is pharmaceuticalcare. Do all the medicationshave an appropriate diagnosisor rationale for use? Are themedications monitored appropriately(ie, laboratory studies, vitalsigns, blood glucose, mood/behaviortracking)? Could any of themedications be contributing to anongoing problem? Is there a saferalternative to a medication with anunfavorable side effect profile? Aregoals of medication therapy beingachieved?

2. Regulatory Review. Fortunately,good clinical practice will satisfy mostregulatory requirements; however,the consultant always has to look atthe medication regimen as if theywere a CMS surveyor and ensurecompliance with CMS standards.

3. Pharmacoeconomic Review. Considermedication cost as well asnursing administration time in theregimen review. Does the regimencomply with the resident?s prescriptiondrug provider formulary?Although not required, nursinghome residents and the facilitieswill appreciate this.

Any irregularities or recommendationsnoted in the medication regimenreview are reported to the attendingphysician and nursing staff.

A consultant pharmacist?s responsibilitiesgo beyond the medicationregimen review. Consultant pharmacistsserve on a number of interdisciplinarycommittees. Quality Assurancecommittees establish policiesand protocols for medication use, reviewmedication errors, and developplans to minimize them, review infectioncontrol issues, and address anyfacility-specific issues related to pharmacyservices or medication use.

In addition to serving on variouscommittees, consultant pharmacistsalso are educators, frequently usedby SNFs for preparing and deliveringin-service education programs.A consultant pharmacist also mayundertake medication-pass observationsand medication storage auditsto ensure appropriate administrationand storage of pharmaceuticals.Excellent verbal and written communicationsskills are essential.

If you are considering a career inconsultantpharmacy, here are a fewrecommendations:

• If geriatrics is not required in your curriculum, take it as an elective. Medication management for seniors is different from that of a younger adult population.
• Intern with an LTC provider
• If you are entering your sixth year, register for an LTC elective rotation that includes exposure to consultant pharmacy
• Join the American Society of Consultant Pharmacists (ASCP) (www.ascp.com)?it is a tremendous resource
• Attend an ASCP meeting, especially the ?Orientation: 60 Steps to Success? session. This is an excellent opportunity to network.

My view toward LTC pharmacy 9years ago was completely wrong. Iam challenged every day, and no 2days are alike. Professionally, I havebenefited from having an opportunityto serve a frail, elderly populationin need of quality care. Personally, Ihave benefited from having an opportunityto work closely with nurses,physicians, and other health care professionalswhose daily efforts towardcaring for our patients are nothingshort of heroic. If you are lookingfor something a little more dynamic,intellectually stimulating, with variedresponsibilities and the opportunityto make a difference in a patient?s life,this might be for you.