Use of PRN medications in skilled nursing facilities

Many elderly individuals in skilled nursing facilities (SNFs), afflicted with an array of acute and chronic diseases, may have as many as 20 different prescribed medications administered on a pro re nata (PRN) basis. In this study, 20 SNFs in Indiana were inspected. Data on PRN medications were taken from medical charts to determine the extent of PRN medication use by the patients. From one to 10 PRN medication were prescribed per patient; 47% of the patients had not used any of their PRN medications. Further data are needed to justify PRN medication prescribing and usage and to decrease the potential for hidden medical costs, adverse drug effects, and drug interactions.     

Decreased medication costs in a skilled nursing facility by clinical pharmacy services

After 1 month of monitoring the drug regimens of 25 randomly selected skilled nursing facility patients, clinically trained pharmacists were able to decrease the total number of medications from an average of 6.0 medications per patient to 4.2 medications per patient. Not only was the number of prescribed medications decreased, but also the total number of administered doses was decreased by 18.6%. The potential additive savings to the state of Washington through decreases in the number of state-funded medications, and to the skilled nursing facilities through decreases in nursing medication administration time, amount to $0.40 per patient per day or approximately $1.7 million annually.     

Pharmaceutical services in long-term care facilities: a certificate approach to teaching skills

The University of Tennessee College of Pharmacy has developed a certificate program for Pharmaceutical Services in Long-Term Care Facilities. Pharmacists who are required to provide such services generally have had minimal experience in doing so. The certificate is composed of six home-study courses, a researched paper, and an on-site clerkship experience. Each pharmacist is evaluated for his or her mastery of the material at regular intervals. The program is designed to be completed in 6 months.     

Evaluation of a training program to improve clinical competencies of pharmacists serving skilled nursing facilities

Forty-eight pharmacists from the New York area were selected for specialized training in consultant clinical services to skilled nursing home facilities. A skills curriculum was developed, and the pharmacists participated in 15 training sessions which included lectures by nationally recognized experts, audiovisual presentations, and on-site clinical workshops. Evaluations were based upon clinical preprogram v. clinical postprogram testing, comparisons with clinical pharmacy experts, and attitudinal pre- and postprogram testing. It was found that the training course did improve the skills of the trainees but they still performed at a level below recognized clinical pharmacy experts. Future programs should stress fewer topics, but in more detail, and should focus upon monitoring techniques, laboratory results, and more on-site experiences.     

Pharmaceutical services in U.S. hospitals in 1989.

The results of a spring 1989 national survey of hospital-based pharmacy services are reported. The study group (n = 2112) comprised half of U.S. acute-care general surgical or medical hospitals with 50 or more licensed beds. Pharmacy directors were asked about their hospital's provision of 14 clinical pharmacy services. The survey had a response rate of 56% (1174 usable responses). Provision levels varied significantly with the pharmacy drug delivery system for 14 services, pharmacy director's education for 12 services, hospital teaching affiliation for 12 services, hospital ownership for 9 services, hospital size for 9 services, and geographic region for 5 services. The following percentages of respondents offered specific services: drug-use evaluation, 90%; inservice education, 66%; adverse drug reaction (ADR) management, 46%; drug therapy monitoring, 41%; pharmacokinetic consultations, 40%; parenteral-enteral nutrition team participation, 28%; patient medication counseling, 26%; drug therapy protocol management, 25%; cardiopulmonary resuscitation (CPR) team participation, 25%; clinical research, 22%; drug information, 16%; participation in medical rounds, 13%; poison information, 9%; and medication histories, 2%. Pharmacist staffing requirements for clinical services usually centralized within the department were highest for drug information and poison information. Within hospitals offering the services, four of nine patient-specific services were potentially available to more than half the patients: ADR management, CPR team participation, drug therapy monitoring, and nutrition team participation. Drug therapy protocol management required the most pharmacist staff time. Only one service, pharmacokinetic consultations, was justified by more than half of the providers of that service. Respondents expected all the services to undergo net growth during 1989-90. The 1989 National Clinical Pharmacy Services Survey showed that provision of clinical pharmacy services varied with the pharmacy drug delivery system, pharmacy director's education, hospital teaching affiliation, hospital ownership, hospital size, and geographic region.     

Pharmaceutical services in rural hospitals in Illinois--2001.

The results of a survey characterizing pharmaceutical services in rural hospitals in Illinois are reported and compared with results of a similar survey conducted in 1991. A questionnaire was developed and mailed to pharmacy directors at rural hospitals in Illinois to obtain information about product-related services, the use of technology, clinical pharmacy services, and human resources data (including vacancies) for 2001. Of the 71 surveys that were mailed, 47 pharmacy directors (66%) responded. Respondent hospitals were smaller compared with those responding in 1991 (mean average daily census, 41.0 versus 51.2, respectively). As in 1991, nearly all respondents reported the provision of unit dose services and complete and comprehensive i.v. admixture programs (100% and 83%, respectively, for 2001). Three respondents (6%) reported having a cleanroom facility. The most commonly used technology reported was nursing-unit-based automated drug dispensing cabinets (35%). Nearly all hospitals reported providing drug therapy monitoring, patient education and counseling, pharmacokinetic consultations, and nutritional support. Consistent with national reports, staffing levels and vacancies increased between 1991 and 2001. In 2001, the mean number of full-time equivalents was 7.1, with a pharmacist to technician ratio of 1.0:1.08 and a ratio of pharmacists to occupied beds of 1.0:22.6. The overall vacancy rate was 8%, with a vacancy rate of 14% and 5% for pharmacists and pharmacy technicians, respectively. A 2001 survey of pharmacy departments in rural hospitals in Illinois showed progression in the provision of distributive and clinical pharmacy services since 1991. Employee vacancy rates in pharmacy departments were high in 2001, especially among pharmacist positions, but were lower than those reported for the general population of hospitals.     

Pharmaceutical services in rural hospitals in Illinois--1991.

The results of a 1991 survey of pharmaceutical services in rural hospitals in Illinois are reported and compared with the results of previously published national and regional surveys. A questionnaire was developed and mailed to the director of pharmacy at each hospital in the study population (n = 95 rural hospitals in Illinois) to obtain information about inpatient drug distribution services, ambulatory-care services, clinical services, and human resources. The response rate was 81% (77 usable responses). Respondents reported a mean hospital size of 115.5 licensed beds. The mean average daily census was 51.2. Drug distribution systems appear similar to those reported in the 1990 ASHP survey, with complete unit dose drug distribution systems existing in 90.1% of respondent rural Illinois hospitals and complete and comprehensive i.v. admixture services in 71.2%. The percentage of pharmacy departments that are decentralized is lower among rural Illinois hospitals than among previous survey populations. Respondents indicated that they provided the following clinical pharmacy services: drug therapy monitoring (73%), patient rounds (12.2%), nutritional support (37.8%), pharmacokinetic consultations (32.4%), and patient education and counseling (24.3%). These results are comparable to those reported in previous surveys. Respondents reported an average of 5.9 full-time equivalents per hospital pharmacy department. The pharmacist vacancy rate and the total vacancy rate per department were reported as 10% and 5.3%, respectively, with vacant positions taking an average of 15 months to fill. The pharmacist vacancy rate is markedly higher than that reported in the 1990 ASHP survey. Rural Illinois hospitals are comparable to other U.S. hospitals in the provision of most pharmaceutical services.(ABSTRACT TRUNCATED AT 250 WORDS)     

Legal requirements for pharmacists to destroy unused medications in skilled nursing facilities. – A 50 state review and insights based on the Covid-19 pandemic

A novel challenge presents itself when the law requires a pharmacist be on site to perform their required duties, such as destroying unused medications, however a skilled nursing facility is not allowing them to enter the property due to a pandemic. Current laws regarding drug destruction are unclear and vastly differ among the states. At times, there is even conflict between skilled nursing facility laws and regulations with pharmacy laws and regulations. This legal analysis reveals that the states are divided into 4 general groupings. 1) Where a pharmacist is physically required on site to destroy medications, 2) a pharmacist is not needed on site to destroy medications, 3) a pharmacist is likely not needed on site to destroy medications; however, the terms “witness” and “presence” are not defined and 4) it is unknown based on the states laws whether a pharmacist is required on site to destroy medications. States would benefit from amending their laws and regulations to explicitly allow pharmacists to either destroy medications themselves when onsite or delegate the drug destruction to a trusted, responsible member of the healthcare field so long as the pharmacist is able to virtually witness said destruction.     

Recent developments in federal reimbursement for home health-care services and products

The current status of reimbursement for home health-care (HHC) products and services is described, and the influence of competition and consolidation on the HHC industry is discussed. Despite inadequate financing and reimbursement pressures, the demand for HHC services continues to grow. The degree of competition in the HHC industry is reflected in bundling of services (gathering payments for services into a single per-capita rate), prospective price negotiations, and competitive bidding. This competition within the home-care industry and pressure on operating margins have spawned a flurry of recent mergers, acquisitions, and corporate restructuring. HHC agencies and suppliers, particularly durable medical equipment suppliers, have been squeezed by inadequate Medicare cost-finding methods, low reimbursement rates, and a high number of denials of Medicare coverage. Three important recent federal measures revised definitions of Medicare coverage, established minimum and maximum payment periods for Medicare reimbursement, reduced payments for services and products covered under Medicare Parts A and B, resurrected prospective-pricing demonstration projects, reduced payments for durable medical equipment and home oxygen supplies, and expanded coverage of services for AIDS patients. State Medicaid program budgets are threatened by recurring administration proposals to cap federal matching payments and by the adoption of a competitive-bid approach to health-care contracting. To survive over the next few years, home health agencies and home-care suppliers will need to monitor operating costs even more closely and pay attention to the patient (payer) mix.