How can your pharmacist help?

[Rdaily]

first, let me begin by stating that i am not a nurse, i am a pharmacist so i apologize in advance for invading your blog, but i wanted to reach out to the nursing community to get your opinion on utilization of pharmacist in a non-traditional home health setting. i am hoping to branch out into this area of healthcare because as a hospital pharmacist i all to often see elderly patients admitted and sometimes discharged on inappropriate meds that can lead to serious injury (i.e. unadjusted doses of antibiotics for renal function, inappropriate duration of therapy of medications, inappropriate dosing / frequency of medications and potential drug-drug interactions). i have also had the opportunity to speak with some owners of home (non-nurses) who house elderly residents who may not be administering medications appropriately (diabetic medications w/ and w/o food, bisphosphonates in supine positions etc..) i have even had the chance to speak with patients who just didn't understand how they were suppose to be taking their meds even after counseling at their pharmacies (coumadin twice daily). i am hoping to tap into this area to help possibly address some of these issues before patients end up hospitalized, injured or dead, but i was wondering if as nurses you could utilize pharmacist in this setting, and if so what other areas of concern do you have medication related where you think a pharmacist may be useful. i have been met with some resistance so i was just wondering if i may be wasting my time. thanks in advance.

[RN1263]

Are you saying you want to be hired by a home health agency?.... I doubt if that would be possible seeing that nurses are the ones required to teach regarding medications and I don't think your services could be billable under medicare or other insurance. Of course, it would be wonderful for a pharmacist to be on staff for education, however I doubt an agency would hire you with decent pay for your services, because they are not reimbursable.

[KateRN1]

I agree with above in terms of reimbursement, it's just not feasible. However, for staff education it would be heavenly! Also for med reconciliation, just having a PharmD to look over the meds and identify any interactions would be the most awesomest thing ever. Of course, my A#1 dream is to have all hospitalists and consulting physicians send their patients home on appropriate meds, with the right dosages, prescriptions in hand, after making sure the patients have prescription coverage to pay for them. But then, as my daughter says, I must be smoking crack.

[drmorton2b]

As an experienced Pharmacy Tech before I was a nurse I understand exactly where your coming from.

I wish someone would come up with a MUST TAKE WITH FOOD/WITHOUT FOOD DRUG LIST: Example Synthroid

[ventmommy]

As a parent, I would love to have ONE pharmacist that consistently looked over the 14 medications that my son is on. They are prescribed by peds, GI, pulm, neuro, nephro, endo and hematology. Especially true when he has an infection and comes home on antibiotics that have to be fit into an already complicated schedule!

[tewdles, RN]

This is a feature that we enjoy in hospice, the presence of a pharmacist on the interdisciplinary team...

[Rdaily]

i appreciate the feedback. i am very passionate about helping people to understand what they are taking and why, and helping to avoid potential adrs there is a thing called mtm (medication therapy management) that is reimbursed under medicare. patients must meet certain criteria in order to be eligible, but it is in the community retail setting. most pharmacies don't provide it because it must be fit into an already hectic work load.

i sincerely believe that the services are needed and am very passionate about it. i didn't choose pharmacy based on what it paid but instead on my passion for helping people. who knows, maybe someone will take a chance and see the value of it. it only takes one. i'll diligently press on until i find that one!

thanks again

[HealthyNurse]

I think that you have a great idea. As another poster mentioned, pharmacists are strongly utilized on the team in hospice care. For many home care patients, it would be wonderful to have this type of resource available. Medication reconciliation is always a challenge in home care (as well as every other setting). As you know, many patients have numerous specialists that they see and the PCP (or ordering physician) doesn't necessarily know what meds the patient is taking that have been prescribed by other physicians. A pharmacist would be very helpful with simplifying the medication regimen and ensuring the patient is getting the most effective treatment. I know that some home care agencies/physicians are work with pharmacists to handle coumadin dosing. Another need would be assistance to the home health agency to develop best practice protocols; for example, aggressive symptom management in the home is the buzz in home care right now. Some agencies are developing protocols for treatment of CHF and other high risk diseases. A part of these protocols would involve medications, such as doubling the dose of current diuretic, adding IV diuretic, etc. Just a thought...

[tewdles, RN]

Even as a home care nurse I often collaborated with the pharmacist that filled the Rx's for my patient. I had no reservation in calling them and asking questions about the meds, spacing, side effects, interactions, etc.

This was often a new concept for the patients...discovering that the pharmacist was available to THEM when they had questions.