Defining Specialty Pharmacy Nursing as a "Specialty"

Nursing in the practice of specialty pharmacy has become a highly specialized practice.

Specialty Pharmacy Nursing has evolved from the “specialty pharmacy” division of programs within the traditional pharmacy services to the highly specialized therapies used for patients with rare chronic disorders. No longer confined to the hospital setting, these specialty therapies are now delivered in alternative care sites such as the home and physician offices.

Nursing involvement in the practice of specialty pharmacy therapy has also become a highly specialized practice. During the last 10 years, the role of the nurse in specialty pharmacy therapy has evolved tremendously. The specialty pharmacy nurse is responsible for integrating the principles of biologic agents and nursing, therapy management, marketing, education, and performance improvement into the patient’s plan of care.

Clinical expertise is of utmost importance for the specialty therapy to be administered safely and effectively. It requires knowledge of pharmacology, infection control, and the technology necessary to administer these “hi-touch” therapies—as well as standard nursing practice—to attend to the physical and psychosocial needs of patients.

Since the 1990s there has been an increased recognition of the need for specialty pharmacy nursing. The reasons for this need in specialty pharmacy nursing include:

• Limited focus on hi-touch therapies through traditional home health care

• Limited access to hi-touch nurses

• Geographical restrictions related to licensure and certification of home health agencies

• Insufficient reimbursement for hi-touch nursing services

Traditionally, specialty pharmacies have managed the hi-touch nursing services through their pharmacy or hub. Reimbursement from the payer often is not sufficient to meet the costs of the hi-touch nursing service required, leaving the specialty pharmacy with the financial responsibility of providing the nursing services from its cost center. In addition, the specialty pharmacy and hub spend multiple administrative hours locating a home health agency or independent contractor who has the expertise and skill level required for the therapy within the geographical area of the patient.

Because specialty pharmacies are not in the business of providing nursing services, they have limited guidelines and standard operating procedures in place to validate the nurse/ agency competency, thus leaving the specialty pharmacy at risk regarding the skill level and quality of care delivered in the home.

The growth of specialty pharmacy nursing continues as advances in pharmacology and technology are developed. As new biologic agents whose hi-touch method of administration continues to increase, so too will the need for the specialty pharmacy nursing role. In fact, new business entities—with their primary focus being on specialty pharmacy nursing services—continue to emerge. The goal of these entities is to provide the specialty pharmacy industry with qualified clinicians whose knowledge and skill levels are validated by Nursing Standards of Practice.

These specialized nursing services not only offer the industry the missing link of care, but also play an integrated role in the collection of evidence-based clinical data that is sure to contribute to improving the clinical outcomes and quality of life for the patients and their families who deal with the burdens of their chronic illness.

Ms. Gregory, RN, BSN, is founder and President of the Specialty Pharmacy Nursing Network (SPNN). She has more than 30 years of experience as an oncology/ infusion nurse and combines her clinical knowledge with an entrepreneurial spirit to be the industry’s leading resource in the growth and development of the specialty therapy practice of nursing. SPNN is one of the first specialty pharmacy nursing services to provide a nationwide network of qualified nurses to meet the needs of the specialty pharmacies and biotech manufacturers. The organization’s services include coordination of care, drug administration, first dosing, education, data collection and reporting, and on-call coverage for specialty therapies. Visit www.spnninc.com for more information. Ms. Gregory will focus on key trends and issues, as well as the role of today’s specialty pharmacy nurse, in subsequent columns.