The Responsibilities of the consultant pharmacist.
OVERVIEW OF CONSULTANT RESPONSIBILITIES
RESPONSIBILITIES OF A CONSULTANT PHARMACIST
The responsibilities of a consultant Pharmacist vary
considerably based on the type of practice setting
I. The Four Primary Responsibilities in all practice
settings include:
1. Drug Regimen Review (D.R.R.)
2. Medication Administration Review (Common Med Errors)
3. Review of Charting Documentation
4. The Storage of Medication ( Physical Inspection)
II. Other Common Responsibilities of the Consultant
Pharmacist
5. Drug interactions
6. Adverse Drug Reactions
7. Dug allergies
8 Drug usage in facility (Rx's/Patient/Month)
9 Antipsychotic Drug Use and Dosage Reductions
10 Benzodiazepine Use and Dosage Reduction
11 Tracking supporting diagnoses for each drug in use
12 Drug Use Evaluation (DUE) studies
13 Development of policies and procedures
14 Development of Treatment Protocols
15. Committee involvement for P & T issues, quarterly
meetings and Infection Control
16. Preparing the consultant report to the facility
17. Tracking the nursing and physician responses
to consultant comments.
18. Formulary compliance for product shifting (Therapeutic Interchange)
19 Monitoring patient outcomes
III. Areas of Responsibility That Lend Themselves To Computerization
1. Chart Review of Drug Therapy (DRR)
2. Preparation of monthly Consultant Report
3. Tracking the nursing and physician responses to consultant comments.
4. Drug interaction scanning
5. Drug Allergy scanning
6. Review of drug usage in facility (Rx's/Patient/Month)
7. Antipsychotic Drug Use and Dosage Reductions
8. Benzodiazepine Use and Dosage Reduction
9. Tracking supporting diagnoses for each drug in use
10. Drug Use Evaluation (DUE) studies
11. Formulary compliance for product shifting
12. Monitoring patient outcomes
13. Conducting industry research
MONITORING DRUG THERAPY IN THE NURSING HOME (THE DRUG REGIMEN REVIEW)
I. The drug therapy of each resident MUST be monitored
monthly
II. The Consultant must sign and date each Resident's chart monthly
and either :
1. Document any areas of concern in a written note
2. If there are no concerns the Consultant must document "No Irregularities
Noted"
III. The key areas of the chart reviewed by the Consultant
Pharmacist
1. The Physician Order Sheet (P.O.S.)
2. The Telephone Orders written since the last review
3. The Medication Administration Record (M.A.R.)
4. The Nursing Notes
5. Lab reports taken since the last review
6. The M.D.S.
7. The resident's Care Plan
IV. Minimum Standards set for the review process
1. The Federal Indicators
2. The Unnecessary Drug Regs
3. The Quality Indicators
V. What are we looking for?
1. All drugs orders being signed monthly
2. Telephone Orders being signed in a timely manner
3. Match meds ordered against meds being administered (see MAR)
4. Review new orders to rule out the possibility of treating an unidentified
adverse effect
5. Review nursing notes to rule out unidentified adverse drug reactions
6. Make sure that all doses are within normal geriatric range
7. Make sure duration of therapy is appropriate
8. Make sure that dosage reductions are attempted on the anxiolytic
and antipsychotic drugs
9. Make sure there is a supporting diagnosis for each order
10. Review PRN drug usage to ensure they are not becoming routine orders
11. Review Lab values to identify sub-therapeutic or toxic levels or
irregularities caused by current therapy
VI. Required Documentation of the Drug Regimen Review
1. sign and date every chart
2. prepare individual comments for every concern or irregularity
3. prepare a monthly report that summarizes the entire D.R.R. for the
D.O.N. and Medical Director
4. Follow up on previous recommendations to ensure that every Prescriber
has responded
5. Prepare a quarterly report that summarizes what has happened during
the past 3 months of Drug Regimen Reviews
comments in the nursing home setting:
6) The types of clinical comments that should be expected
by the consultant were defined and included:
(1) Use of concurrent laxatives
(2) When should blood pressure be taken
(3) When should pulse be taken
(4) drugs that were considered inappropriate
(5) appropriate reasons for using antipsychotic
drugs
(6) appropriate doses of antipsychotic
drugs in the elderly
(7) appropriate doses of anxiolytic drugs
(8) appropriate doses of antidepressants
(9) labs that are required with certain
medications
7) Indicators were intended to help the surveyor determine
whether the consultant is doing a good job of evaluating drug therapy.
(c) 2002 - Pharmacy Care Specialists, Inc. - All Rights Reserved
