Working with a Consultant Pharmacist to Open an ASC (Ambulatory Surgery Center) is something every organization should consider. Opening an ASC requires extensive organization and collaboration between various experts. Involving a highly qualified consultant pharmacist among your team of expert advisors will help ensure patient safety, regulatory compliance, and survey success. Are you considering opening an ASC? Have you gathered all the necessary advisors to ensure your grand opening is as seamless as possible?
Opening an ASC can be difficult, so don’t go at it alone. It requires a lot of expertise, preparation and detail-oriented execution. It starts with financial planning, documenting ownership and decision-making responsibilities, not to mention either retrofitting an existing building or building from the ground up. Once you get beyond these important basics, organizations will need to consider licensing, accreditation and all the items required to accomplish these tasks. It is during these steps that a consultant pharmacist can be an invaluable member of your team. And don’t just hire someone who calls themselves a consultant. An expert consultant can be vital and provide superior guidance, but working with someone who is average or not fully qualified could be a huge liability. To learn more about picking a pharmacist that will be an asset, read my post “Are you working with a highly qualified consultant pharmacist?”.
How can your consultant pharmacist help?
State licensure and accreditation: Depending on your state of practice, your surgery center may need to obtain and maintain state licensure. Each state is different, so you’ll want to start communicating with your department of health as early as possible. Starting early will allow you to learn the licensing requirements and required processes. This will help avoid unnecessary delays in obtaining the required licensure.
Additionally, many facilities are also Medicare-certified and accredited by organizations such as the Accreditation Association for Ambulatory Health Care (AAAHC), The American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) and The Joint Commission (TJC). Accreditation often lets ASCs be deemed Medicare-certified, and to measure their services and performance against national recognized standards via benchmarking. Benchmarking is an expectation of the accrediting organizations and something we are expert at. We provide comprehensive benchmarking services. To learn more about our benchmarking, please read our post “Ambulatory Surgery Center? Get Benchmarking Done with a Consultant Pharmacist.” Benchmarking in not only a requirement, it helps facilities improve quality of care.
Medication management: What are some of the medication management items you should consider in preparation for licensure and accreditation? The list is long and requires a bit of legwork, but a good consultant pharmacist can lead the way and save you time and money. As an example, here are three processes you will need to develop:
- High alert medications: When used in error, these drugs carry a higher risk of causing significant patient harm. High alert medications require special attention and a consultant pharmacist can help ensure this happens. Some tips? Post the most recent list and ensure your staff is continuously educated on the contents of the list. Use warning labels for both Look-Alike-Sound-Alike and High-Alert medications. If the labels on the shelf are bent, frayed or in any way hard to read, replace them with fresh and clear versions. The Institute for Safe Medication Practices (ISMP) is a great resource for obtaining a current list of high-alert medications.
- Look-Alike-Sound-Alike Medications: These medications require special safeguards to reduce the risk of errors and avoid patient harm. A consultant pharmacist can help to make sure you’ve established, and are following, best practices. Some tips? Post your organization’s ‘Look-Alike-Sound-Alike’ list for all staff members to see and refer to, and make sure the list is specific to the medications currently used at your facility. If formulary changes are made, the list should be updated too. You can develop your list based on the Institute for Safe Medication Practices (ISMP)List of Confused Drug Names.
- Compounded Drugs: Will your facility use compounded drugs? If so, take steps to protect your patients and let a consultant pharmacist help you do a proper assessment of any outsourcing facility prior to ordering products. Is the pharmacy providing the compounded drugs an FDA registered 503B outsourcing facility? According to a 2019 report from the U.S. Department of Health and Human Services Office of Inspector General, about 11% of hospitals get compounded drugs from sources that are not registered with the FDA. This leads to increased risks to your patients and liability for your facility and staff.
We provide guidance and support for all aspects of pharmaceutical services. This will enhance regulatory compliance, which helps improve patient safety and your chance at a successful survey. Regulations and standards are almost always developed to ensure optimal care for our patients, however, they are often misunderstood and sometimes applied incorrectly. Working with a consultant pharmacist who is fluent in certification and accreditation standards can go a long way to relieve the amount of work facilities have to take on themselves. A great consultant pharmacist will not only perform audits to ensure compliance, they offer guidance on developing systems to meet regulatory requirements, which ultimately leads to a positive impact on patient care.
Controlled substances licensure: This requires a bit of preparation and following specific processes. You will need a state specific controlled substance license which will then allow you to obtain a Drug Enforcement Administration (DEA) registration. Upon obtaining a DEA registration, you then need to develop your process for ordering controlled substances. Should you use the Controlled Substance Ordering System (CSOS), which allows for secure ordering of controlled substances without the use of the paper DEA-222 form, or will you be using the paper DEA-222 form? Do you need to have power of attorney? Your consultant pharmacist should be able to walk you through this entire process and guide you on all these questions.
Policy and Procedures: Do you have all the necessary policies and procedures? Are they up to date? Do they follow current standards and best practices? As part of our routine services, we develop and share policies with our facilities to assist them in complying with survey standards. This is another time-consuming area that ASCs often struggle with. It requires a lot of time and effort to constantly develop and update policies and procedures. Having a policy is not enough: compliance is critical. Your consultant pharmacist should routinely help evaluate compliance with stated policies, and this is best accomplished through frequent comprehensive on-site evaluations.
Formulary management: You will need to develop a formulary. Who will take on this task? Formulary development is a good opportunity to use the guidance of your pharmacist to ensure patient safety, but it is also an opportunity to cut costs. Drug shortages seem to be happening with more frequency, making it difficult for patients, prescribers, and facilities. We provide our facilities with suggestions for other ways to obtain medications and therapeutic alternatives. Your consultant pharmacist should be a “go to” resource for you to brainstorm options during drug shortages or to assist with formulary management. Although the COVID-19 (coronavirus) outbreak may impact production, the truth is that overbuying and hoarding of medications will likely also impact availability. The most commonly impacted classes are antibiotics, anesthetics and controlled substances. Is your facility taking the necessary steps to avoid disruptions in patient care? In a recent post, we provided Ten Steps to Dealing with Drug Shortages. To learn more read our blog post, “Ten Steps to Dealing with Drug Shortages“.
Antibiotic Stewardship: As we all know, antibiotic stewardship is a critical component of a good infection control program. Which antibiotics should you use and when? How about perioperative management of antibiotics? Do you have a plan to deal with prophylaxis and antibiotic timing? As you develop your infection control program, tap the knowledge of your consultant pharmacist to ensure you are on solid ground and prepared to not only meet, but exceed all regulatory and clinical requirements.
Education: As you move closer to opening, you will also need to step up your efforts in educating your staff. Education doesn’t, and shouldn’t, only happen in a classroom. Education can range from answering questions to having a one-on-one learning discussion with a staff member. Don’t miss this opportunity to start off on the right foot by asking your consultant pharmacist to provide trainings to staff prior to opening.
If you are considering opening an ASC, now is the time to engage the services of a consultant pharmacist. Although it seems self-serving, I will always encourage facilities to have a consultant pharmacist on their team and it is never too early to start that process. Not only does it give you a leg up on your competition, it also gives you expert guidance on proper setup, meeting regulatory requirements, patient safety and help in avoiding costly mistakes, it also helps you perform many tasks in a more efficient way. There is nothing more frustrating than spending a significant amount on a task or process only to find out it was incorrect and needs to be redone. Let us help you get it right the first time. If you aren’t working with a consultant pharmacist or need additional guidance or expertise, please contact us. We are always here to support you.
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.
