Rotation 5: Long Term Care

Posted by Unknown at Friday, November 09, 2018

Hello again.

I can't believe I'm done with rotation 5 of 9! This year has been speeding by!
I am so thankful for all the opportunities I've had in the last 6 months of rotations. I have been able to apply the information learned in the first 3 didactic years and have experienced some lesser known areas pharmacists are involved.

One of areas I had the opportunity to explore was long term care. A long term care pharmacy is a pharmacy that prepares and dispenses medications (and sometimes medical supplies) to patients residing in various long term care facilities (skilled nursing facilities, assisted living homes, etc.). Not only do they supply the medications, but pharmacists work as consultants for the long term care facilities to meet CMS requirements. CMS (Center for Medicare and Medicaid Services) requires all patients in skilled nursing facilities to receive a monthly drug-regimen review by a pharmacist. These pharmacists travel to the facilities and often look through both paper and electronic medical charts to assess drug regimens for safety and efficacy. These pharmacists then make recommendations to the providers about necessary monitoring, discontinuing medications, decreasing doses and other clinical suggestions to best care for these patients.

For the last 5 weeks, I worked at a local Long Term Care pharmacy that services long term care facilities across Central and Southeast Michigan. There were a wide variety of responsibilities and tasks to complete both in the pharmacy and on the road. When I was in the pharmacy, I participated in electronic order verification, antibiotic dosing, clozapine REMS monitoring and warfarin dosing. I also completed medication reviews for new admits and residents that had fallen and served as the final check for prescriptions before they left the pharmacy. When I was on the road with one of the consultant pharmacists, I helped review the paper and electronic medical records and helped make recommendations for the providers.

I really enjoyed my time on this rotation. The people were amazing to work with and I liked the variety of responsibilities. It was eye opening to learn about another area that pharmacists can make a difference in (other than the well known community/retail and hospital jobs).

Now that this rotation is done, I am transitioning into my "off rotation". I will be working, preparing for the ASHP Midyear Meeting and getting everything ready for residency applications. I'll make sure to post again soon to let you know how everything is going!

Thanks for reading.

Laura

Long Term Care

Posted by Melanie at Sunday, May 06, 2012

My final rotation (can't believe I am blogging about my final rotation) is Long Term Care at HomeTown Pharmacy.  It is a nontraditional rotation and is something very unique that is not covered a lot in school.

My home base is at the HomeTown Pharmacy in Chelsea.  My preceptor works four 10-hour days (which can sometimes go longer).  Three of these days she is consulting (which basically means chart review) for nursing homes/assisted living facilities across the state and the other day she works from the pharmacy.  She is responsible for reviewing each patient's chart once a month.  She has homes she consults for in Ann Arbor, Southfield, St. John's, Saginaw, Bad Axe, Okemos, and Ingham County.  Each month she reviews ~700 charts.

When she reviews the charts, she looks for appropriate drug-dosing, renally adjusting medications, appropriate medication for diagnosis, drug-interactions, appropriate lab monitoring, and gradual dose reductions for antidepressants, antipsychotics, anxiolytics, and hypnotics, as appropriate.  The maximum number of charts that she is allowed to review each day is 100; however, as many of you have spent some time working up patients, this is a rather large number of charts to review in a single day.  She usually reviews about 70 a day.  On my first day, I reviewed 2 patient charts, which she says is typical for students.  Of course, it takes longer to review a chart for a new patient than it does for a patient you have reviewed before because you can spend less time on the background and past medical history and focus on picking up where you left off (basically focus on the past month).

If you think you may be interested in Long Term Care and becoming a consultant pharmacist, I would highly recommend this rotation.  Do not be intimidated that your sites are all over the state because my preceptor and I meet in Chelsea and she drives the company car.  It really is a unique experience because you are at a different place/city almost every day.