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 patient care. Our goal is maximizing patient function and quality of life while minimizing the number of medications needed. Currently, we average over six 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 our physicians and average a 93% 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 patient 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 patients

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, a Pharm.D. from the academic arena, dispensing pharmacists and senior management from purchasing personnel. Each drug class is reviewed for the most appropriate medication selection for our patients. 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 patient, 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
Savings realized by our Medication Formulary, as well as any updates to the formulary made during the quarter
Consultant pharmacists’ 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.

Can assisted living patients 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 nursing care, training and devices, such as infusion pumps.

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 ICF/MR 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 patients 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.

Why is less better than more when it comes to resident medication profiles?

Additional medications can equal unnecessary costs while creating risk for drug interaction potential, disease interaction potential, a sense of dependency in making day-to-day healthy lifestyle choices and a lack of proper drug monitoring.

Medication misadventures are the #1 reason for hospital admissions. With each medication added, the risk increases for an adverse drug reaction or a drug-drug interaction. Sometimes, a drug is added to the patient’s regimen to combat a side effect of a previously added medication. It can be quite difficult to make sense of this when the average patient now takes over 10 routine mediations. Our consultant pharmacists are highly trained and experienced in sorting out these issues.

Why should we choose Skilled Care Pharmacy over another local or national pharmacy?

It’s called old-fashioned “hometown” service with “uptown” expertise. As a mid-size provider, we have the capabilities to be responsive to your pharmacy requests by assigning designated personnel with intimate knowledge of your staff and operational expectations. In other words, we offer the personal touch.

Conversely, smaller does not necessarily mean leaner in the realm of knowledge or experience. Skilled Care professionals are the best in their field with extensive backgrounds in geriatric and long-term care. They work tirelessly to ensure your residents receive the minimal amount of medication necessary to improve or maintain their medical conditions with the least amount of risk. Consultants are generous with their knowledge, sharing best practices as well as pharmaceutical and clinical information with facility staff and residents in order to expedite quality care and promote wellness understanding.

Skilled Care also prides itself on its innovative practices, something the local pharmacy may not be able to match. Our state-of-the-art operations allow us to minimize costs to facilities and residents while providing us leverage to offer many unique products and services that no longer exist from national competitors and are considered unaffordable by smaller pharmacies.

What packaging options does Skilled Care Pharmacy offer?

Packaging is customized to facility request. Skilled Care offers unit dose, bubble or blister pack/cards dispensed on either a calendar or cycle fill basis, or multi-dose packaging.

Does Skilled Care Pharmacy offer any advice or assistance to Medicare Part D questions and concerns?

Our reimbursement representatives are knowledgeable in all aspects of Medicare Part D enrollment regulations, third-party insurance drug formularies and beneficiary requirements. They will gladly review resident drug profiles at facility or resident request and identify those Medicare Part D programs that would be the most advantageous to the individual.

How can Skilled Care Pharmacy save our staff time and/or money?

Utilization of clinical best practices and continuous quality improvement initiatives creates the framework for generating notable savings in time and money for Skilled Care clients.

Our medication reduction effort decreases medication administration time for the nurses and delegated staff. Proactive formulary application by our pharmacists reduces drug costs to both the facility and resident. This savings is accomplished on resident admission through our PAR Program and throughout the resident’s stay when new medications are ordered or when the attending physician accepts the Consultant Pharmacist’s recommendations.

Our dedicated STAT process and controlled substance ordering protocol minimizes nursing interaction time with Skilled Care staff and expedites the dispensing and delivery of these medications. The medical records department monitors corrections to resident medical records and identifies opportunities to the respective facility for saving nursing time at monthly turnover.

Complimentary drug storage audits relieve nursing staff of the time-consuming responsibility of ensuring the safe and secure handling of medications. Additionally, we offer an efficient one-touch drug replacement system for both the manual and automated emergency drug supplies that saves nursing time and expedites the return of those medications to the facility stock.

Our automatic calendar fill and cycle fill systems save nurses a vast amount of medication re-ordering time every day and dispensing initiatives, such as multi-dose packing, not only saves medpass and reordering time but reduces potential for medication errors as well.

We also provide a unique purchasing opportunity to facilities that allows them volume pricing discounts on over the counter medications not normally available from other resources

And lastly, our Medicare Part D transition team assists facilities and families helping residents choose the most suitable drug plan. We provide third-party formulary comparisons that support the best coverage and potential savings based on each individual’s medication regimen so that residents and families can make independent, informed decisions regarding their coverage.