What is a consultant pharmacist, and what does he/she do?
A consultant pharmacist is a clinical pharmacist specially trained in
the areas of geriatrics and long-term care. Consultant pharmacists review medication
regimens for each resident in the nursing facility monthly. Reviews are done every
other month or quarterly for some residents in assisted living facilities (by facility
request and state requirements). They work closely with the facility staff, physicians/nurse
practitioners and other interdisciplinary team members to ensure optimal patient
care. Our goal is maximizing patient function and quality of life while minimizing
the number of medications needed. Currently, we average over six requests for medication
discontinuations for every one request for medication addition. We also make recommendations
regarding medication dose reduction, duration of therapy, medication monitoring
(lab work, vital signs, etc.), drug interactions, potential adverse drug reactions
and medication substitutions for greater efficacy, reduction in nursing med-pass
time and decrease in costs. Our consultant pharmacists enjoy an excellent working
relationship with our physicians and average a 93% positive response rate to recommendations.
Xubex Care Pharmacy Consultant Pharmacists are also available for clinical
questions, drug information, survey support, medication bill reviews and for participation
on various committees such as QA/CQI Committees, Fall Prevention, Weight Management
and Psychotropic Medication Committees.
reducing the number of medications important?
Medication misadventures are the #1 reason for hospital admissions from
the nursing facility. The more medications a patient takes, the greater the risk
for drug-drug interactions and adverse drug reactions. Decreasing the number of
medications also decreases drug costs. Besides the obvious costs of drug dispensing,
passing fewer medications reduces nursing time and frees the nurses up to perform
other duties. Xubex Care Pharmacy believes in the goal of minimizing medication
therapy while still providing optimal care for our patients
Xubex Care Pharmacy protect the residents from drug-related problems?
Xubex Care Pharmacy Consultant Pharmacists review each resident’s medications
on a monthly basis to screen for drug-related problems. We also track any adverse
drug reactions reported to us by facility or Xubex Care Pharmacy staff. These are
tracked and reviewed each quarter by our Regulatory Committee. Any trends can be
identified and an action plan put into place.
is the Xubex Care Pharmacy Formulary, and how is it developed?
Xubex Care Pharmacy has a Formulary Committee that is charged with developing
and maintaining our Medication Formulary. This committee comprises clinical pharmacists,
from the academic arena, dispensing pharmacists and senior management from purchasing
personnel. Each drug class is reviewed for the most appropriate medication selection
for our patients. Cost is certainly considered along with 10 criteria such as third-party
coverage, efficacy, side-effect profile, dosage forms and ease of administration.
Resident quality of care is the most important consideration in this process. The
resultant formulary is presented to the facilities for approval annually. This process
provides incredibly significant cost savings to the facility. Formulary cost savings
is presented at the quarterly QA/CQI Meetings.
information is provided by Xubex Care Pharmacy at our QA/CQI Meetings?
Our Consultant Pharmacists and Customer Care Account Managers are active
participants in your QA/CQI Process. We attend and provide a report including, but
not limited to the following:
Average medication count per patient,
broken down by station, if requested, and compared to a Xubex Care Pharmacy average
for like-sized facilities
Average psychotropic mediation
use by category and compared to State and National averages
Savings realized by our Medication
Formulary, as well as any updates to the formulary made during the quarter
Consultant pharmacists’ recommendations
by category and the physician response rate to these recommendations
Customer Care activity during the
Clinical Education activity during
Any other consultant pharmacist
services performed, including the results of any QA surveys performed
Medication errors for the quarter
Stat delivery report including
numbers, which medications and “on-time” percentages
Clinical packet: developed by the Consulting
and Clinical Education department and including information on new medications,
drug warnings, indications, new regulations, new guidelines and new clinical studies
pertinent to long-term care.
Xubex Care Pharmacy control your medication costs?
Acceptance of the Xubex Care Pharmacy Medication Formulary has a huge
impact on drug costs. Xubex Care Pharmacy also has a stock OTC program that allows
you to purchase over-the-counter medication at extremely competitive pricing. This
helps combat the recent problem of Medicaid non-coverage for OTC products, as well
as allows convenient daily delivery of stock items. Consultant pharmacists, as mentioned
above, work to decrease the number of medications used and also strive for less
frequent, or daily dosing whenever possible.
How does Xubex Care Pharmacy educate nursing facility staff
on new developments pertinent to long-term care?
Xubex Care Pharmacy’s clinical education department provides a monthly
“clinical packet” with updates on regulations, care guidelines, suggested protocols,
new policies and any other timely topics. An extensive clinical packet is also distributed
at all QA/CQI Meetings. Individualized in-facility in-service programs are available
on request from our consultant pharmacists and clinical nurses. Additionally, we
sponsor as well as co-sponsor various all-day and half-day educational events that
focus on topics of importance to the long-term professionals within our communities.
living patients receive 90-day supplies of medications?
In some but not all cases, three-month supplies of medications are available
to residents who are self-medicating. Contact your dedicated pharmacist in each
if a resident needs infusion therapy?
We offer a full range of IV and other infusion therapy services, including
nursing care, training and devices, such as infusion pumps.
does a pharmacist review medication regimens in long-term care facilities?
Our consultant pharmacists review medications monthly for residents
in long term care facilities. Assisted living and other types of facilities also
have the option of using consulting pharmacy services. Assisted living and ICF/MR
facilities usually have their residents reviewed on a quarterly basis. Our consultant
pharmacists are also available for extra reviews upon request for situations such
a frequent falls, adverse effects, concern with cost of meds/insurance coverage
or any other medication concern.
does the pharmacist do when a problem/issue arises with a medication?
When issues arise, Xubex Care Consultant Pharmacists contact the prescribers
to make recommendations in written, faxed or direct form. Our pharmacists also offer
to meet with prescribers at the facility to discuss medication concerns as well
as perform clinical consults upon the request of any practitioner. The internal
staff pharmacists generally contact the facility to notify them of medication concerns
such as drug contraindications, drug to drug interactions, allergy profile and other
dispensing issues or when necessary, communicate these problems directly to the
How does the pharmacist ensure that recommendations are the
Our Formulary Committee evaluates safety, efficacy and costs of medications.
Our consultant pharmacists help to ensure that the formulary selection is used whenever
possible, to keep costs low. The consultant pharmacists also have many other cost-saving
recommendations they make above and beyond formulary adherence. We strive to maintain
the patients functional well being while using the least number of medications possible,
always striving to discontinue unneeded medications, and only requesting medications
be added when the benefit clearly outweighs the medication cost.
less better than more when it comes to resident medication profiles?
Additional medications can equal unnecessary costs while creating risk
for drug interaction potential, disease interaction potential, a sense of dependency
in making day-to-day healthy lifestyle choices and a lack of proper drug monitoring.
Medication misadventures are the #1 reason for hospital admissions.
With each medication added, the risk increases for an adverse drug reaction or a
drug-drug interaction. Sometimes, a drug is added to the patient’s regimen to combat
a side effect of a previously added medication. It can be quite difficult to make
sense of this when the average patient now takes over 10 routine mediations. Our
consultant pharmacists are highly trained and experienced in sorting out these issues.
we choose Xubex Care Pharmacy over another local or national pharmacy?
It’s called old-fashioned “hometown” service with “uptown” expertise.
As a mid-size provider, we have the capabilities to be responsive to your pharmacy
requests by assigning designated personnel with intimate knowledge of your staff
and operational expectations. In other words, we offer the personal touch.
Conversely, smaller does not necessarily mean leaner in the realm of
knowledge or experience. Xubex Care professionals are the best in their field with
extensive backgrounds in geriatric and long-term care. They work tirelessly to ensure
your residents receive the minimal amount of medication necessary to improve or
maintain their medical conditions with the least amount of risk. Consultants are
generous with their knowledge, sharing best practices as well as pharmaceutical
and clinical information with facility staff and residents in order to expedite
quality care and promote wellness understanding.
Xubex Care also prides itself on its innovative practices, something
the local pharmacy may not be able to match. Our state-of-the-art operations allow
us to minimize costs to facilities and residents while providing us leverage to
offer many unique products and services that no longer exist from national competitors
and are considered unaffordable by smaller pharmacies.
packaging options does Xubex Care Pharmacy offer?
Packaging is customized to facility request. Xubex Care offers unit
dose, bubble or blister pack/cards dispensed on either a calendar or cycle fill
basis, or multi-dose packaging.
Xubex Care Pharmacy offer any advice or assistance to Medicare Part D questions
Our reimbursement representatives are knowledgeable in all aspects of
Medicare Part D enrollment regulations, third-party insurance drug formularies and
beneficiary requirements. They will gladly review resident drug profiles at facility
or resident request and identify those Medicare Part D programs that would be the
most advantageous to the individual.
Xubex Care Pharmacy save our staff time and/or money?
Utilization of clinical best practices and continuous quality improvement
initiatives creates the framework for generating notable savings in time and money
for Xubex Care clients.
Our medication reduction effort decreases medication administration
time for the nurses and delegated staff. Proactive formulary application by our
pharmacists reduces drug costs to both the facility and resident. This savings is
accomplished on resident admission through our PAR Program and throughout the resident’s
stay when new medications are ordered or when the attending physician accepts the
Consultant Pharmacist’s recommendations.
Our dedicated STAT process and controlled substance ordering protocol
minimizes nursing interaction time with Xubex Care staff and expedites the dispensing
and delivery of these medications. The medical records department monitors corrections
to resident medical records and identifies opportunities to the respective facility
for saving nursing time at monthly turnover.
Complimentary drug storage audits relieve nursing staff of the time-consuming
responsibility of ensuring the safe and secure handling of medications. Additionally,
we offer an efficient one-touch drug replacement system for both the manual and
automated emergency drug supplies that saves nursing time and expedites the return
of those medications to the facility stock.
Our automatic calendar fill and cycle fill systems save nurses a vast
amount of medication re-ordering time every day and dispensing initiatives, such
as multi-dose packing, not only saves medpass and reordering time but reduces potential
for medication errors as well.
We also provide a unique purchasing opportunity to facilities that allows
them volume pricing discounts on over the counter medications not normally available
from other resources
And lastly, our Medicare Part D transition team assists facilities and
families helping residents choose the most suitable drug plan. We provide third-party
formulary comparisons that support the best coverage and potential savings based
on each individual’s medication regimen so that residents and families can make
independent, informed decisions regarding their coverage.
Xubex LTC Pharmacy utilizes a 5 Star Medication Tracking System
to ensure accuracy. Packaging and labels are inspected and errors are identified
before the medications leave the pharmacy. There are five pharmacists checks relative
to every medication received and dispensed.
1. Orders are triaged and organized in order of importance upon receipt
2. Orders are then checked by two Pharmacists prior to being filled
3. Visual check by Pharmacist after orders are filled
4. Pharmacist completes a Bar Code Scan to match drug/Rx to each patient
5. Pharmacist Delivery Manifest check – Bar code scan matching right patient, right
drug, right strength, right facility
Monitoring drug/drug and drug/food interactions will be coordinated through computer-based
drug profiles maintained for all residents. Drug interactions and drug/food interactions
are flagged prior to filling. When interactions occur that could lead to clinical
complications, the facility is notified immediately. Drug allergies will also be
monitored via our QS1 First Data Bank computer system. Pharmacy data entry personnel
are warned of drug allergies prior to prescription dispensing. The facility is notified
and alternative therapies recommended.
Xubex Pharmacy clinical pharmacists conduct prospective drug utilization
reviews at intake. The goal is medication reduction via elimination of duplicate
therapies, overdoses and unnecessary medications. Our clinical pharmacist will work
collaboratively with facility’s D.O.N. and medical director.
With the plethora of insurance plans and corresponding formularies today, we understand
that it is a challenge for doctors to be aware of what is covered for a patient.
That is why we make it a part of our job to assist the doctor and the patient in
obtaining the most cost effective medications. We constantly evaluate patient Med
D plans to ensure the selected plan meets patient needs. Disease states change and
it is important that this function be part of pharmacy practice.
Xubex Pharmacy has experience working with multiple payers. Pre
Admission screening is an integral part of pharmacy performance to aid residents
in cost analysis. When medications or products are not covered, the facility and/or
the patient’s representative are contacted.