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How to work with a consultant pharmacist.

They're important players on the team -- but sometimes just don't feel that way

"YOU'RE BACK AGAIN? YOU WERE JUST HERE."

"WE DON'T HAVE AN IN-SERVICE TODAY, DO WE?"

"WILL THIS IN-SERVICE TAKE LONG? I HAVE A LOT OF WORK TO DO."

"YOU CAN'T HAVE THE MED BOOK YET. I HAVEN'T SIGNED OUT MY MORNING MEDICATIONS."

"DID YOU BRING US ANY BROWNIES?"

Ahh, the friendly greetings the consultant pharmacist gets upon entering a long-term care facility.

What is a consultant pharmacist to you? Does the term conjure up images of someone who enters your facility unannounced and wreaks havoc on the nursing staff, only to leave a nasty 15-page report that can't possibly be responded to by the next visit? Do the nurses CRINGE when they have to call the physicians to request action on the consultant's recommendations?

One hopes not, because there are positive ways your consultant pharmacist can impact your facility.

Consultant pharmacists are capable of providing many services, both clinical and technical. It is important for the Administrator and Director of Nursing to be aware of the capabilities of their consultant pharmacist and to determine how they fit into the facility's overall plan for providing quality care to their residents.

It is important to know, for example, what the consultant's relationship is with your vendor pharmacy. Often, staff members automatically assume the consultant works for the pharmacy, though he or she may in fact be an independent contractor. In that case, it will probably not benefit the facility to lodge complaints with the consultant about the vendor, since the consultant has no direct contact with the vendor pharmacies. It is better in this situation for the Administrator and Director of Nursing to establish a contact at the vendor pharmacy itself with whom to discuss medication errors, billing problems or overall operational complaints. If, however, the consultant pharmacist does work for the vendor pharmacy, then it is of course completely appropriate to approach the consultant with any complaints regarding the vendor, since part of the consultant's function is to act as liaison between the pharmacy and the facility.

An important fact to make known to your consultant pharmacist is the level of involvement you expect concerning such matters as infection control, quality assurance and safety. Some facilities simply ask the consultant to attend meetings, but don't seek his or her input. Ask for participation. For instance, the consultant can easily do studies to determine if drug therapy, lack of drug therapy or catheter irrigation infrequency is lending to the increasing number of urinary tract infections in the facility. Also, tell the consultant what information is expected on quarterly reports (i.e., average number of medications per resident or a current psychotropic list). If your corporation requires a standard quality assurance form, allow the consultant to complete the pharmacy audit and report findings at the meeting. This gives the pharmacist some sense of involvement and will potentially improve the quality of service provided.

Although active participation in the facility is desirable, most consultant pharmacists work on a very rigid schedule, with a set number of charts and medication carts to audit by the end of each month. Many consultants travel hundreds of miles weekly and are often out of town. It can be difficult for them to juggle quality assurance meetings, in-services and State Board of Health visits. For this reason, it is best to notify your consultant as far in advance as possible regarding any facility meeting at which you wish their participation. This allows adequate time for preparation of a report and increases the likelihood of attendance. Though tentative, tell the consultant in what month you expect the State surveyors so that he or she can properly prepare for the visit.

Consultant pharmacists are becoming more involved in the survey process. When possible, contact your consultant upon arrival of the surveyors. This eliminate the "middle man" when dealing with the pharmacy. If the surveyors have a question, it can be readily addressed. This would hopefully defer potential citations resulting from lack of procedural knowledge on the part of the surveyors. The facility and the surveyors should feel comfortable utilizing the pharmacist as a source of information.

Consultants have access to an even broader information base today, with the onset of the computer age. General drug references as well as the most recently published drug studies can be readily retrieved using some laptop computers. Also, in preparing for the survey, there will be no more panic to find the August 1992 report or to clean the coffee stain off of the in-service on antihypertensives before the State Surveyors appear. When these records are computerized, the consultant can easily generate a new copy for the facility files and can FAX it "while you wait." (Is technology great or what?)

The space requirements for this new technology, however, add to the already lengthy list of limitations faced by consultants in long-term care facilities. Now, in addition to struggling for use of the medication books and competing with careplan conferences for the use of the charts, comes the endless search for an outlet when the two-hour battery back-up on the computer gives out. (Sometimes technology isn't so great.)

Though computers and other products of modern technology are helpful, effective consulting is based on an ongoing cooperative relationship between Administrators, Directors of Nurses and Consultant Pharmacists, with all striving toward one goal: Optimal quality of care for all residents.

Guidelines for Improving the Relationship

1. Be aware of the consultant's relationship with the vendor pharmacy. Know when to approach them with operational-related problems and when to contact the vendor pharmacy directly.

2. Notify the consultant of quarterly or other meetings requiring his or her participation as far in advance as possible.

3. Make in-service expectations known to the pharmacist. If possible, plan in-service date and topics several months in advance, with the understanding that either can be changed if necessary.

4. Ask the consultant what reports can be provided to help in the creation of careplans, MDSs or quarterly evaluations.

5. Contact the consultant with concerns about drug administration. For example, if between visits, controlled substances are found to be missing, the consultant can perform an audit to determine the severity of the problem and make recommendations for monitoring and follow-up.

6. Use the pharmacist as a source of drug information. Don't be afraid to draw upon consultants' expertise.

7. Notify the consultant when the State Board of Health arrives. Let them worry about the pharmaceutical aspect of the survey. There are other areas more deserving of the attention of the Administrator and Director of Nursing.

8. Invite the pharmacist to care plan conferences and other interdisciplinary meetings where family members and physicians may be present. This reinforces the team approach to health care.

9. When considering restructuring of the facility, entertain the idea of a room designated specifically for consultants, with ready access for them to the charts and outlets.

10. C-O-M-M-U-N-I-C-A-T-E

Julie M. Flick, RPh, FASCP, is Director of Consulting Services, PRN Pharmaceutical Services, Inc., in Indianapolis, IN, and Associate Professor of Pharmacy Practice at Butler University College of Pharmacy, also in Indianapolis.
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Copyright 1993, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.

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Author:Flick, Julie M.
Publication:Nursing Homes
Date:Jul 1, 1993
Words:1192
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