Contribution of the Consultant Pharmacist to Rational Drug Usage in the Long‐Term Care Facility*

Abstract

In a rural 116-bed skilled nursing facility, a study was made of the influence of a Consultant Pharmacist on drug usage over a one-year period. Lines of communication were established with the six attending physicians by means of work rounds, telephone calls, and both official and unofficial memoranda. Daily pharmacy rounds were conducted with health-care students and the nursing supervisor, who facilitated physician-pharmacist communication. The physician-nurse-pharmacist team studied each patient's problems, the status of the therapeutic endpoint, and the need of and usage of each regularly scheduled or pro re nata (PRN) drug. Stop-order and standing-order protocols were developed. During the one-year period, the number of regularly scheduled drugs per patient was reduced from 3.30 to 2.66 (19.4 percent decrease), and of PRN drugs from 3.92 to 2.12 (45.9 percent decrease). The overall significant reduction was associated with the protocol and stop-order discontinuances of routinely scheduled drugs, and with the duplicated orders for drugs to relieve pain, nausea, vomiting, diarrhea, colds and cough. Implications for optimal care of the patients, and for the economics of this federally-mandated system of consultant pharmacists are discussed.

Risk of adverse drug events by patient destination after hospital discharge

“…While LTC patients, who have been mandated to receive comprehensive pharmacy services since 1974, 35,55,56 did display the highest prevalence of three risk factors (hypoalbuminemia, cognitive impairment, and psychiatric drug use), the HHC population had a significantly higher prevalence of four others, suggesting that outpatients who receive HHC services are at comparable or higher risk of ADEs or AHEs than LTC patients.…”

“…While certain characteristics (e.g., illness and drug burdens) have been shown to contribute to the risk of an ADE, such characteristics have not been widely employed as a means of allocating pharmaceutical care resources, with levels of pharmaceutical care historically being determined entirely by the physical location of the patient (i.e., outpatient, nursing home, or hospital). While intensive pharmaceutical care services are undoubtedly of value to patients in institutions, [35][36][37][38] the failure to provide comparable levels of care to the highest-risk ambulatory care patient results in unacceptably high rates of ADEs. 4,11,12,[17][18][19][20] Home health care (HHC) agencies and other providers now offer high-acuity home clinical services previously available only in the inpatient setting.…”

Mental Health in Nursing Homes

“…Medical directors ofnursing homes and consultant pharmacists can monitor and advise on medication use (Cooper & Bagwell 1978;Gurwitz et al 1990;Ouslander et al 1991); they are available to do so in most US nursing homes. Medical directors ofnursing homes and consultant pharmacists can monitor and advise on medication use (Cooper & Bagwell 1978;Gurwitz et al 1990;Ouslander et al 1991); they are available to do so in most US nursing homes.…”

The Role of the Pharmacist in a Geriatric Nursing Home: A Literature Review

“…An Indiana study of skilled care facilities found that 47 percent of the patients did not use their prn medications at alJ.21 Finally, Cooper and Bagwell report a 34 percent decrease in the number of ordered prn medications after a pharmacist's review. 20 One of the most important benefits of a reduction in nursing home prescriptions is the monetary saving documented in numerous studies. The most frequently cited figures are those calculated by Kidder.…”