Consultant pharmacists are medication management specialists who work in a variety of settings such as ambulatory surgery centers, senior care facilities (e.g., nursing homes, assisted living facilities) and with individual patients. They provide expert advice on pharmaceutical services, patient safety, and drug therapy management.
Last month we discussed how consultant pharmacists assist ambulatory surgery centers. With this post, we’ll focus on how senior care facilities can benefit from using an expert consultant pharmacist. Do you worry about hospitalizations, rehospitalizations and regulatory compliance? Here are some tips from a consultant pharmacist.
It’s well known that for elderly patients, medication related problems are a key factor behind hospital admissions and readmissions. Further, it is well documented that most of those admissions and readmissions are preventable. Seniors are at a greater risk for medication-related problems than other populations. There are various factors at work here, but mainly seniors are at risk because aging leads to physiological changes and a higher rate of multiple chronic diseases (which often leads to a greater number of medications — both prescription and OTC). According to a study published in the New England Journal of Medicine, warfarin, insulins, oral anti-platelet agents, and oral hypoglycemic medications are the leading causes of emergency hospitalizations for adverse drug events (ADEs) in patients 80 years and older. It has also been noted that nearly half of all emergency hospitalizations for ADEs occur in patients 80 years and older.
So, what exactly does your consultant pharmacist do?
If you work in a long-term care facility, you should be seeing your consultant pharmacist at least once a month…but do you know what he or she actually does? Did you know that your consultant pharmacist is worried about most of the same things you are? Here’s a very brief summary of what an expert consultant pharmacist is focused on when working with senior care facilities and how they can be one of your best resources.
- The medication regimen review: This is a big umbrella term that encompasses many things. One of the essential functions of a consultant pharmacist is to review every medication to ensure it seems appropriate for that patient. This includes having an adequate diagnosis to support the use of the medication, confirming that dosing is adequate to treat the given condition (not too high, not too low), ruling out adverse events, drug-drug and drug-disease interactions, assessing monitoring parameters/laboratory results, and ensuring the patient’s goals are being met. The use of any medication comes with a risk versus benefit analysis. We always want the benefit to the patient to outweigh any potential risks. To this end, there are additional considerations to weigh such as medications that either carry a potentially higher risk, like those noted on the “Beers criteria” list or maybe the medication has a “Black Box Warning” from the FDA, which means the medication carries certain life-threatening risks. These are some of the items a pharmacist will consider while reviewing each patient.
- Progress notes: The findings of the comprehensive review performed by the consultant pharmacist should culminate in the writing of a progress note. The note will vary from patient to patient and typically focuses on items addressed during the medication regimen review. This is also a good place to document any irregularities found as well as to track gradual dose reductions for psychotropic medications.
- Regulatory compliance: This is always a big topic of discussion because facilities are very focused on avoiding survey issues (surveys are performed by certification and accreditation bodies such as the Centers for Medicare and Medicaid Services (CMS) and The Joint Commission (TJC)). Preparation for the next survey is always ongoing and a good consultant pharmacist treats every day like survey day. Additionally, regulations are in place to ensure patient safety and we believe that if you do the right thing for the patient, you almost always end up on the right side of the regulation. This is also where documentation of your decisions is important.
Your consultant pharmacist should confirm that the clinical approach seems appropriate and further, provide guidance on any issues that seem to be at odds with a given rule or regulation. This should lead to both good patient and survey outcomes.
- Audits: Most facilities believe their consultant pharmacist is doing an audit when they review patient charts. We are not the pharmacy police. The time spent in a chart is mostly time spent on clinical issues and the medication regimen review as described above. That said, we do perform audits. Your consultant pharmacist should be the resource for all things pharmacy. This includes auditing all processes such as ordering, receiving, storage, administration, wasting and destruction. Additionally, your pharmacist should focus on these processes as they pertain to controlled substances, an area of special focus in light of the ongoing opioid epidemic.
- Reviewing patients who are newly admitted, short stay or with change in condition: Did you know CMS requires a medication regimen review to be performed by a pharmacist on every single admission, short stay patient, or anyone with a noted acute change in condition? Not only is this a requirement, but facilities are mandated to have a policy and procedure in place to address these situations. How are you communicating these situations to your consultant pharmacist? Is there a process in place? Does your consultant pharmacist take a proactive role in addressing these reviews to help you improve patient care and minimize liabilities? Hopefully the answer is yes. If not, consider working with a consultant pharmacist who is well-versed in these certification standards and who will help you improve patient care, reduce your costs (especially Medicare Part A), and facility liability.
- Quality Assurance/Quality improvement meetings: Your consultant pharmacist should attend these meetings at least quarterly. Although the format of the meeting is generally consistent, don’t miss out on the opportunity to improve your chances of a successful survey by being creative. Ask your pharmacist to contribute in ways that enhance your program. At OctariusRx, we like to briefly discuss ongoing survey issues as well as to provide pertinent clinical updates. Doing so ensures the senior care facility is aware of best practices.
These are some of the main components of what your consultant pharmacist does each month. Maybe you are already familiar with these services and make the best use of the resources you have, but perhaps there are some additional ways your pharmacist can help you hadn’t considered.
How can your consultant pharmacist help?
Survey readiness: This is the most obvious way facilities would like to benefit from the services of their consultant pharmacist. A good consultant pharmacist can help their facilities prepare for survey ahead of time, but did you know your pharmacist can also help you during survey? As a consultant pharmacist, I have personally been involved in countless surveys and have spoken with many surveyors from various surveying agencies. Your consultant pharmacist may be able to resolve a survey deficiency before a surveyor ever writes it up. You shouldn’t wait until after survey to contact your pharmacist.
Education: Education is a critical component for every facility. You can never have too much education and with staff shortages and turnover, it seems like a never-ending battle. Involve your consultant pharmacist in this process to enhance the education being provided by your staff development leader and broaden the types of topics presented. In addition to classroom education, use every visit as an opportunity for question and answer sessions to better prepare your staff. Speaking of preparation, what are you doing about medication management, administration and patient safety? Your consultant pharmacist should be able to assist with yearly medication competency assessment and ongoing medication administration (Med-pass) observation.
Psych meetings: Are you having monthly meetings to discuss patients receiving psychotropic medications? Most facilities have a recurring meeting, but they don’t get the most out of it because they never involve psych services or their consultant pharmacist. Having a consultant pharmacist present is a proven way to enhance regulatory compliance and reduce the use of psychotropic medications. Your consultant pharmacist is an expert at medication management and the complicated regulatory requirements that go along with using psychotropic medications in a long-term care facility.
Risk meeting: The frequency of this meeting varies from facility to facility and it often addresses patients that are at high risk for things such as falls, weight loss, and pressure ulcers. You may not realize it, but medications are often to blame for causing, or exacerbating, many of these issues. Since you already have a medication expert in the building (your consultant pharmacist), include them in the meeting. If they are not in the building the day of the meeting, consider having your consultant pharmacist join via conference call, or even better, video conference. It is extremely easy and ultimately improves patient outcomes.
Reducing medications/costs: Two of the most common complaints I hear when it comes to medication in long-term care are: 1) patients are on too many medications and 2) the medications cost too much. What’s a good way to resolve or mitigate these problems? You guessed it: work with your consultant pharmacist! A good consultant pharmacist is eager to work collaboratively with nurses and prescribers to minimize the number of medications being used and at the same time, offer suggestions for more cost-effective ways to achieve the same goal. In the end, the patient benefits from the convenience and better outcomes from fewer medications, the nurse benefits from a streamlined medication pass and the facility benefits from saving money on both medications and nursing time.
By now you have a much better idea of what your consultant pharmacist does on a monthly basis. Equally important, you should have a better understanding of the additional ways a good consultant pharmacist can help you, your patients and your facility. This is far from comprehensive and there are still more ways you can collaborate with your consultant pharmacist. If you have any questions or would like to discuss ways to enhance patient care, regulatory compliance and survey success, contact us anytime for a free consultation.
The Consultant Pharmacists at OctariusRx provide guidance on safe medication management, survey readiness and cost savings to ambulatory healthcare facilities/surgery centers, senior care facilities and pharmacies We also help individual patients optimize their medications to improve their quality of life and save money. Contact us for assistance.