Long-term Care Pharmacy Research Articles

Benchmarking 2010: Measuring Long-Term Care and Consultant Pharmacy Practice

The American Society of Consultant Pharmacists, with support from the pharmacy management software company QS/1, has completed its 2010 survey to determine industry standards for long-term care pharmacy operations, consultant pharmacist practice, and the use of health information technology in the long-term care setting. The report presents data collected in this annual business benchmarking survey. Examples of data include gross profit margins of long-term care/closed-door pharmacies, pharmacists' salaries, prescription payer mix, consultant pharmacist productivity and contracting, and implementation of technology solutions such as ePrescribing, electronic medication administration records, electronic medical records, and automated dispensing.

Effect of a Pharmacist‐Led Multicomponent Intervention Focusing on the Medication Monitoring Phase to Prevent Potential Adverse Drug Events in Nursing Homes

To determine the extent to which the use of a clinical informatics tool that implements prospective monitoring plans reduces the incidence of potential delirium, falls, hospitalizations potentially due to adverse drug events, and mortality. Randomized cluster trial. Twenty-five nursing homes serviced by two long-term care pharmacies. Residents living in nursing homes during 2003 (1,711 in 12 intervention; 1,491 in 13 usual care) and 2004 (1,769 in 12 intervention; 1,552 in 13 usual care). The pharmacy automatically generated Geriatric Risk Assessment MedGuide (GRAM) reports and automated monitoring plans for falls and delirium within 24 hours of admission or as part of the normal time frame of federally mandated drug regimen review. Incidence of potential delirium, falls, hospitalizations potentially due to adverse drug events, and mortality. GRAM triggered monitoring plans for 491 residents. Newly admitted residents in the intervention homes experienced a lower rate of potential delirium onset than those in usual care homes (adjusted hazard ratio (HR)=0.42, 95% confidence interval (CI)=0.35-0.52), overall hospitalization (adjusted HR=0.89, 95% CI=0.72-1.09), and mortality (adjusted HR=0.88, 95% CI=0.66-1.16). In longer stay residents, the effects of the intervention were attenuated, and all estimates included unity. Using health information technology in long-term care pharmacies to identify residents who might benefit from the implementation of prospective medication monitoring care plans when complex medication regimens carry potential risks for falls and delirium may reduce adverse effects associated with appropriate medication use.

Health Information Technology: How We Got Where We Are

Consultant and senior care pharmacists probably have already encountered some sort of health information technology (HIT) system in one or more of the facilities they service, whether it is an electronic medication administration record or some version of an electronic health record (EHR). This article will address national HIT initiatives and the role of the American Society of Consultant Pharmacists in HIT activities, HIT adoption statistics in the long-term and postacute care settings, certification of EHR systems, the use of standards in exchanging information between settings and health care providers, and the role of consultant pharmacists and long-term care pharmacies in implementation of HIT.

2010-2011 ASCP President Al Barber: A Man for All Settings

Next month, Albert R. Barber, PharmD, CGP, FASCP, becomes the president of the American Society of Consultant Pharmacists for 2010-2011. What distinguishes his career is his wide-ranging experience in almost every pharmacy setting: retail, long-term care pharmacy, independent consultant pharmacist, clinical administrator for a large health care company. His goals as president are to directly involve more ASCP members and to reach out to pharmacists serving seniors beyond the nursing facility setting.

Medication Chart Orders and the DEA: Long–Term Care Facility Residents Caught in the Middle

In 2009, several field offices of the Drug Enforcement Agency (DEA) began enforcement actions against a number of pharmacies serving long-term care facilities (LTCFs) in Ohio, Michigan, Wisconsin, and Virginia, alleging that the practice of using ‘‘chart orders’’—LTCF nurses calling or faxing prescriptions for Class II–V drugs to the pharmacies—violated certain DEA regulations. Long-term care pharmacies in these states have already been targeted by the DEA for inspection, and many now face huge fines. For example, 1 independent pharmacy was cited with more than 3,000 violations and faces fines of more than $32 million. Other pharmacies have changed their policies to reflect DEA regulations, resulting in significant delays in the delivery of pain medication to nursing facility residents. The DEA’s interpretation of the law prohibits pharmacies from dispensing Class II through Class V medications to LTCFs and their residents, where the prescription/medication order was obtained from the nursing facility by facsimile and where the pharmacy has not received the prescription by the prescriber (physician) with all the required elements. The critical ‘‘missing’’ element in the case of chart orders sent to the pharmacy via fax is usually the physician’s original signature. Although a pharmacy is permitted to fill a medication order transmitted via fax, the regulation requires the fax to be transmitted either by the prescribing physician or the

Implementation of the Fleetwood model of pharmaceutical care in nursing homes: impact on the long-term care pharmacy team

Implementation of the Fleetwood model of pharmaceutical care in nursing homes: impact on the long-term care pharmacy team

Controlled Substances in Long-Term Care Pharmacy: Part 2

Complying with state and federal requirements for controlled substances is crucial for all pharmacies. Specific regulations regarding how controlled substances are ordered, prescribed, dispensed, and stored, as well as strict requirements for disposal and record-keeping, require specific policies and procedures. For pharmacies that primarily dispense medications to long-term care facilities, there can be some unique challenges.

Customer Satisfaction: Assessing the Value Perception and Performance of Consultant Pharmacists and Long-Term Care Pharmacy Providers

Customer Satisfaction: Assessing the Value Perception and Performance of Consultant Pharmacists and Long-Term Care Pharmacy Providers

Medicare Part D and the Nursing Home Setting

The purpose of this article is to explore how the introduction of Medicare Part D is changing the operations of long-term-care pharmacies (LTCPs) and nursing homes, as well as implications of those changes for nursing home residents. We reviewed existing sources of information and interviewed stakeholders across various perspectives. We conducted 31 semistructured telephone interviews with key stakeholders between November 2006 and January 2007. Part D represents a substantial departure from how prescription drugs were previously financed and administered in nursing homes, and nursing home providers and LTCPs have struggled in adapting to some of these changes. Part D increased the variation around formularies and drug management processes for residents at the facility level, creating additional burden on clinical and pharmacy staff and introducing a tension between facilities' need to dispense medications quickly and assuring of coverage for those drugs. Nursing home and LTCP stakeholders perceive wide variation across Part D plans in their ability to meet the needs of nursing home residents. Although LTCPs, nursing homes and their clinicians, and Part D plans will gain experience with the benefit in the nursing home setting over time, stakeholders we interviewed identified a range of longer term issues and questions that merit attention as the benefit proceeds.

This Summer, Medicare Remains Hot Topic

This Summer, Medicare Remains Hot Topic

Rejections Of Drug Claims For Nursing Home Residents Under Medicare Part D

Some nursing facility administrators and physicians have raised concerns about the increased administrative burden of working across multiple Part D prescription drug plans (PDPs), citing the possibility for adverse resident outcomes and financial burden on facilities when PDPs reject drug claims for residents. We examined data on claims in rejected status for one large long-term care pharmacy as of December 2006. There was considerable variation across PDPs in both rejection rates and reasons for rejection.

Pay Relief Tied to Unrelated Funding Issue

Pay Relief Tied to Unrelated Funding Issue

Delivery of Part D Benefits Could Face Changes

Delivery of Part D Benefits Could Face Changes

Implementing Changes to the State Operations Manual

For most consultant pharmacists, long-term care pharmacies, and nursing facilities, preparation for and implementation of the new Pharmacy Services and Unnecessary Medications guidelines in the State Operations Manual will be a multistep process. In the final guidelines released in December 2006, the Centers for Medicare & Medicaid Services made modifications to the "Advance Copy" version of the guidelines released in September 2006. Consultant pharmacists will play a key role in helping facilities interpret the newest version of the guidelines and determine whether they need to alter their processes to maintain regulatory compliance.

Job Satisfaction and Stress Among Pharmacists in the Long-Term Care Sector

To provide normative information regarding levels of job satisfaction and stress between consulting and dispensing pharmacists in the long-term care arena. Cross-sectional. United States. All current members of the American Society of Consultant Pharmacists as of March 2005. None. Health Professional Stress Inventory. More than 90% of consultant pharmacists were satisfied with their jobs. The most frequently reported source of stress among the pharmacists was short staffing, affecting their ability to perform their duties. More than one-third of dispensing pharmacists were often stressed, frequently because of the need to keep up with developments to maintain professional competence. Pharmacists serving the long-term care sector are very satisfied. Methods to assist dispensing pharmacists to keep up with practice developments must be explored. Whether or not new models of long-term care pharmacy improve job satisfaction must be explored.

Pharmacy Profile New ASCP President Robert J. Miller: Entrepreneur Who Puts the Patient First

Bob Miller, known for his enthusiasm and desire to nurture others' growth, brings to his term as 2005-2006 ASCP president the leadership skills and business acumen he developed over two decades as a long-term care pharmacy owner.

Electronic-Prescribing: Will Long-Term Care Be Ready?

Passage of the Medicare Modernization Act has thrust electronic prescribing (e-prescribing) into the forefront of health care technology. Health care providers, payers, and the government are hoping that e-prescribing will improve patient safety, quality of care, and efficiency. However, for long-term care facilities, pharmacies, and prescribers to embrace these changes and incorporate e-prescribing into their every day practices, communication standards will have to be created to facilitate transfer of prescription/order information among all three parties. E-prescribing and electronic health records will be an important element of pharmacy practice that consultant and senior care pharmacists should learn about and prepare for now.

Baseline Job Satisfaction and Stress Among Pharmacists and Pharmacy Technicians Participating in the Fleetwood Phase III Study

To provide baseline levels of job satisfaction and stress among members of the long-term care pharmacy team participating in the Fleetwood Phase III evaluation. Cross-sectional design; long-term care pharmacy provider in North Carolina (the implementation site of the large-scale Fleetwood Phase III study). All current pharmacy employees as of May/June 2002. None. Health Professional Stress Inventory and job satisfaction. Ninety-four percent (16/17) of consultant pharmacists were satisfied with their job, with 89% reporting they would definitely choose to be a pharmacist again. Seventy-five percent both of dispensing pharmacists and pharmacy technicians reported overall job satisfaction. Forty-one reported that they would not choose to be a pharmacist (pharmacy technician) again. The most frequently reported sources of stress among the dispensing pharmacists and pharmacy technicians were conflicts with non-work obligations (i.e., family, personal life) and the ability to perform duties with short staffing. In addition, inadequate pay and few opportunities for job advancement were often/frequent sources of stress among pharmacy technicians. More than one third of dispensing pharmacists also reported stress frequently because of fears of mistakes in patient treatment. Overall, consultants are very satisfied with their positions, although dispensing pharmacists and pharmacy technicians are less satisfied with their work. The reasons may be because of the different nature of each job, as well as staffing shortages. The extent to which the Fleetwood Model can improve job satisfaction and impact on stress will be evaluated once we resurvey the pharmacy team after the intervention period of the Fleetwood Phase III study.

A Comparison of the Costs of Manufacturer Unit-Dose and Repackaged Unit-Dose in Seven-Day Dispensing Systems

To compare the costs associated with manufacturer unit-dose and repackaged unit-dose in seven-day unit-dose dispensing systems to guide purchasing decisions. Retrospective observational economic evaluation. Central Virginia long-term care pharmacy provider servicing 2,020 beds in 13 unit-dose facilities. Costs of manufacturer unit-dose and repackaged unit-dose for the 146 most frequently dispensed drugs. Total costs over six months for manufacturer unit-dose were found to be $1,428,248. This was $14,726 less than repackaged unit-dose at $1,442,974. The major factor contributing to the difference was the cost of inventory destroyed. Sensitivity analyses indicated that the manufacturer unit-dose system was less expensive as long as the acquisition cost of unit-dose drugs was no more than 5.1% higher than that of drugs purchased in bulk bottles. Manufacturer unit-dose was associated with a 1.0% cost-savings over repackaged unit-dose. Lower costs of inventory destroyed outweighed higher acquisition costs.

The new JCAHO pain standards: Implications for pain management nurses

The newly approved Joint Commission on Accreditation of Healthcare Organizations (JCAHO) pain management standards present an important opportunity for widespread and sustainable improvement in pain assessment and management. Unrelieved pain is a major, yet avoidable, public health problem. Despite 20 years of work by educators, clinicians, and professional organizations and the publication of clinical practice guidelines, there have been, at best, modest improvements in pain management practices. Multiple barriers found in the health care system, and among health care professionals, patients, and families, continue to impede progress. In August 1997 a collaborative project was initiated to integrate pain assessment and management into the standards, intent statements, and examples of implementation of JCAHO—a rare opportunity to improve pain management in health care facilities throughout the country. After review by multiple JCAHO committees and advisory groups and critique by an expert panel, the JCAHO Board of Commissioners approved the revisions in May 1999. The revisions are published in the 2000-2001 standards manuals and will be effective January 1, 2001, for all patient care organizations accredited by JCAHO—ambulatory care, behavioral health, health care networks, home care, hospitals, long-term care, and long-term care pharmacies. An evaluation of the impact of the revisions is currently being completed, and education of the JCAHO surveyors and health care professionals is underway. Nurses, especially those with expertise in pain management, are valuable resources as health care organizations change their pain assessment and management processes to meet the new standards. © 2000 by the American Society of Pain Management Nurses