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

Abstract

In a rural 116 bed skilled nursing facility, the influence of a Consultant Pharmacist on drug usage over 1 yr was determined. Lines of communication were established with attending physicians by means of work rounds, telephone calls and 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 patient''s problems, the status of the therapeutic endpoint and the need and usage of each regularly scheduled or pro re nata (PRN) drug. Stop-order and standing-order protocols were developed. During 1 yr, the number of regularly scheduled drugs/patient was reduced from 3.30-2.66 (19.4% decrease) and of PRN drugs from 3.92-2.12 (45.9% decrease). The overall reduction was from 7.22-4.78 drugs/patient (33.8% decrease). The most 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 pharmacacists are discussed.