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Ask a Pharmacist (Skilled Care Customers Only)

Sometimes, a question comes to hand that only a registered pharmacist will be able to answer. At Skilled Care Pharmacy, our team of experienced pharmacists is always available for emergency questions. Simply call us at (800) 786-9418.

If your pharmacy question is less urgent, you may wish to look through the frequently asked questions below or submit a question for a personal reply.

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FREQUENTLY ASKED QUESTIONS

Who should I call to review a resident's medication profile?

If you have questions about the medications being received by one of your residents, you should talk to the pharmacist dedicated to your facility. If you don't know who that is, call (800) 334-1624.

Can assisted living residents receive 90-day supplies of medications?

In some, but not all cases, three-month supplies of medications are available to residents who are self-medicating. Contact your dedicated pharmacist in each specific case.

What if a resident needs infusion therapy?

We offer a full range of IV and other infusion therapy services, including on-site venepuncture assistance, IV therapy training and support devices such as infusion pumps.

How are residents protected from negative drug-drug interactions?

Our Consultant Pharmacists continually review resident profiles and work with the resident's primary care physician to make sure unnecessary medications are discontinued, dangerous medications are removed and the latest, most efficacious and cost-effective medications are used to maximize healthcare benefits.

How do I learn about drug side effects?

Drug information is available for all drugs dispensed by Skilled Care. Simply request that we include a medication guide and whether you desire a professional or resident-centered version. Additionally, facilities are supplied with drug handbooks for the nurses to reference.

If I have questions about how a drug should be administered, who should I call?

The internal pharmacists at Skilled Care or your Consultant Pharmacist can answer those questions. If the concern is related directly to nursing skills or technique, then our staff of knowledgeable Nursing Consultants can provide instruction and insight for managing the medication.

Sometimes, residents are admitted to my facility on multiple high-cost drugs. Can Skilled Care Pharmacy help reduce costs?

Absolutely! Known as the Pre-Admission Review Program, Skilled Care Pharmacy pharmacists routinely evaluate the drug profiles of all new admissions in an attempt to isolate opportunities for switching to formulary substitutions that are less expensive while still maintaining therapeutic equivalency, or instances where medications may be discontinued with physician consent.

What are key concerns regarding storage of drugs?

Skilled Care Pharmacy routinely provides courtesy drug storage audits to assist facilities with proper handling of medications. Our main considerations are storage per pharmaceutical manufacturer's guidelines and regulatory requirements, particularly temperature and light restrictions. The second consideration is route of administration and assuring that internal and external drugs are not stored adjacent to each other. Finally, we focus on security of medications by checking that all storage locations are locked and only authorized personnel have access to the medications.

What's the true interpretation of an "unnecessary" drug?

No longer does a single diagnosis suffice as justification for medication use. Other factors must also be considered such as continued presence of symptoms or condition, correct monitoring of the drug according to standards of practice, appropriate dosage and duration and presence of debilitating side effects or adverse reactions. Consultant Pharmacists utilize the monthly Medication Regimen Review to assist facilities in isolating instances where drug use may be deemed unnecessary and to alert physicians through written recommendations requesting support and justification for the medication.

What is a consultant pharmacist, and what does he/she do?

A consultant pharmacist is a clinical pharmacist specially trained in the areas of geriatrics and long-term care. Consultant pharmacists review medication regimens for each resident in the skilled nursing facility monthly. Reviews are done every other month or quarterly for some residents in assisted living facilities (by facility request and state requirements). They work closely with the facility staff, physicians/nurse practitioners and other interdisciplinary team members to ensure optimal resident care. Our goal is maximizing resident function and quality of life while minimizing the number of medications needed. Currently, we average over eight requests for medication discontinuations for every one request for medication addition. We also make recommendations regarding medication dose reduction, duration of therapy, medication monitoring (lab work, vital signs, etc.), drug interactions, potential adverse drug reactions and medication substitutions for greater efficacy, reduction in nursing med-pass time and decrease in costs. Our consultant pharmacists enjoy an excellent working relationship with physicians and average a 90% positive response rate to recommendations.

Skilled Care Pharmacy Consultant Pharmacists are also available for clinical questions, drug information, survey support, medication bill reviews and for participation on various committees such as QA/CQI Committees, Fall Prevention, Weight Management and Psychotropic Medication Committees.

Why is reducing the number of medications important?

Medication misadventures are the #1 reason for hospital admissions from the nursing facility. The more medications a resident takes, the greater the risk for drug-drug interactions and adverse drug reactions. Decreasing the number of medications also decreases drug costs. Besides the obvious costs of drug dispensing, passing fewer medications reduces nursing time and frees the nurses up to perform other duties. Skilled Care Pharmacy believes in the goal of minimizing medication therapy while still providing optimal care for our residents

How does Skilled Care Pharmacy protect the residents from drug-related problems?

Skilled Care Pharmacy Consultant Pharmacists review each resident's medications on a monthly basis to screen for drug-related problems. We also track any adverse drug reactions reported to us by facility or Skilled Care Pharmacy staff. These are tracked and reviewed each quarter by our Regulatory Committee. Any trends can be identified and an action plan put into place.

What is the Skilled Care Pharmacy Formulary, and how is it developed?

Skilled Care Pharmacy has a Formulary Committee that is charged with developing and maintaining our Medication Formulary. This committee comprises clinical pharmacists, dispensing pharmacists, and senior management from purchasing personnel. Each drug class is reviewed for the most appropriate medication selection for our residents. Cost is certainly considered along with 10 criteria such as third-party coverage, efficacy, side-effect profile, dosage forms and ease of administration. Resident quality of care is the most important consideration in this process. The resultant formulary is presented to the facilities for approval annually. This process provides incredibly significant cost savings to the facility. Formulary cost savings is presented at the quarterly QA/CQI Meetings.

What information is provided by Skilled Care Pharmacy at our QA/CQI Meetings?

Our Consultant Pharmacists and Customer Care Account Managers are active participants in your QA/CQI Process. We attend and provide a report including, but not limited to the following:
  • Average medication count per resident, broken down by station, if requested, and compared to a Skilled Care Pharmacy average for like-sized facilities
  • Average psychotropic mediation use by category and compared to State and National averages (Oscar data)
  • Savings realized by our Medication Formulary, as well as any updates to the formulary made during the quarter
  • Consultant pharmacist's recommendations by category and the physician response rate to these recommendations
  • Customer Care activity during the quarter
  • Clinical Education activity during the quarter
  • Any other consultant pharmacist services performed, including the results of any QA surveys performed
  • Medication errors for the quarter
  • Stat delivery report including numbers, which medications and on-time percentages
  • Clinical packet: developed by the Consulting and Clinical Education department and including information on new medications, drug warnings, indications, new regulations, new guidelines and new clinical studies pertinent to long-term care.

How does Skilled Care Pharmacy control your medication costs?

Acceptance of the Skilled Care Pharmacy Medication Formulary has a huge impact on drug costs. Skilled Care Pharmacy also has a stock OTC program that allows you to purchase over-the-counter medication at extremely competitive pricing. This helps combat the recent problem of Medicaid non-coverage for OTC products, as well as allows convenient daily delivery of stock items. Consultant pharmacists, as mentioned above, work to decrease the number of medications used and also strive for less frequent, or daily dosing whenever possible.

How does Skilled Care Pharmacy educate nursing facility staff on new developments pertinent to long-term care?

Skilled Care Pharmacy's clinical education department provides a monthly clinical packet with updates on regulations, care guidelines, suggested protocols, new policies and any other timely topics. An extensive clinical packet is also distributed at all QA/CQI Meetings. Individualized in-facility in-service programs are available on request from our consultant pharmacists and clinical nurses. Additionally, we sponsor as well as co-sponsor various all-day and half-day educational events that focus on topics of importance to the long-term professionals within our communities.

How often does a pharmacist review medication regimens in long-term care facilities?

Our consultant pharmacists review medications monthly for residents in long term care facilities. Assisted living and other types of facilities also have the option of using consulting pharmacy services. Assisted living and intermediate care facilities usually have their residents reviewed on a quarterly basis. Our consultant pharmacists are also available for extra reviews upon request for situations such a frequent falls, adverse effects, concern with cost of meds/insurance coverage or any other medication concern.

What does the pharmacist do when a problem/issue arises with a medication?

When issues arise, Skilled Care Consultant Pharmacists contact the prescribers to make recommendations in written, faxed or direct form. Our pharmacists also offer to meet with prescribers at the facility to discuss medication concerns as well as perform clinical consults upon the request of any practitioner. The internal staff pharmacists generally contact the facility to notify them of medication concerns such as drug contraindications, drug to drug interactions, allergy profile and other dispensing issues or when necessary, communicate these problems directly to the physician.

How does the pharmacist ensure that recommendations are the most cost-effective?

Our Formulary Committee evaluates safety, efficacy and costs of medications. Our consultant pharmacists help to ensure that the formulary selection is used whenever possible, to keep costs low. The consultant pharmacists also have many other cost-saving recommendations they make above and beyond formulary adherence. We strive to maintain the residents functional well being while using the least number of medications possible, always striving to discontinue unneeded medications, and only requesting medications be added when the benefit clearly outweighs the medication cost.