A simple answer is that a consultant pharmacist is a pharmacist who is paid to provide expert advice on the use of medications by individuals or within institutions, or on the provision of pharmacy services to institutions. The phrase "consultant pharmacist," coined by George F. Archambault who is referred to as the "founding father" of consultant pharmacy, originated in the nursing home environment when a group of innovative pharmacists focused on improving the use of medications in these facilities. However, consultant and senior care pharmacists are found today in a wide variety of other settings, including subacute care and assisted living facilities, psychiatric hospitals, hospice programs, and in home and community-based care -- wherever seniors reside.
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Consultant pharmacy practice is a discipline within the profession of pharmacy that has its roots in the provision of pharmacy services to nursing facilities (NFs) and other long-term care (LTC) environments. While the concept of consultant pharmacy originated about three decades ago, today consultant and senior care pharmacists provide a broad spectrum of clinical, distributive, and administrative services to more than 1.8 million NF residents and over 20 million residing in assisted living facilities, hospice, home care, community based-LTC, and naturally occurring retirement communities (NORCs). Check out Consider a Career in Consultant Pharmacy (PDF).
Consultant pharmacists, once relegated to reviewing nursing facility resident’s charts in back rooms or offices, are today interacting directly with residents, caregivers, and primary care providers. Those consultants who have been involved in practice long enough to see the evolution of their role can easily recognize the positive effects that hands-on pharmacist services are having on patient care.
Pharmacists have grown to realize that people are different in real life from the way they appear in a medical record. They are aware that diseases and patient response to pharmacotherapy are frequently individual and not entirely “textbook,” especially in the elderly. Because of this, consultant pharmacists must evaluate each resident as a whole person. Residents must be considered holistically, rather than as several unrelated organ systems or simply by their list of medications.
Today, the roles and practice environments for consultant pharmacists have progressed far beyond what the most optimistic consultant pharmacist would have predicted 20 years ago. The most innovative consultants are providing advanced services including patient care tools, disease management protocols, software development, laboratory services, nutrition services, and clinical research.
Consultant pharmacy practice is not an exclusive practice area that is limited to a few elite individuals. Any licensed pharmacist with the necessary qualifications and motivation can become a consultant pharmacist. Common traits exhibited by successful consultant pharmacists are an ability to adapt to a situation and solve patient care problems, including managing their drug therapy, and a belief that they can make a difference in the quality of life and care of the patient.
A clinical practitioner
The consultant pharmacist uses clinical skills to ensure that patients receive quality, rational, cost-effective pharmaceutical care. Patient care outcomes are enhanced by the consultant pharmacist’s drug regimen review, drug therapy assessment and quality assurance activities.
A member of the health care team
Physicians, nurses, and administrators recognize consultant pharmacists for their clinical and administrative skills and the contributions they make to appropriate drug use and positive patient care outcomes. Consultant pharmacists often participate as a member of multi-disciplinary teams in nursing facilities and for other healthcare providers in the areas of quality assurance, infection control, and behavior monitoring to mention a few.
A patient care advocate
The consultant pharmacist strives to maximize the quality of care and ensure the highest quality of life for his/her patient.
A provider of pharmacy systems
The consultant pharmacist follows a medication order from its point of origin until it is administered to the patient, providing drug distribution and monitoring systems to ensure this process is efficient, rational, safe, and cost-effective.
Excellent communication skills are crucial to effective consultant pharmacy practice. Committee participation, recommendations to physicians, administrative reports, interactions with facility staff and patients and educational programs all require strong verbal and written communication skills.
The consultant pharmacist provides both formal educational programs in the facility and routine drug information to facility staff. The consultant pharmacist also discusses new drug products and the appropriate use of these medications with the nursing and medical staffs.
A regulatory expert
Consultant pharmacists must have a knowledge of the laws and regulatory implications influencing the environment where they practice. For example, nursing facilities have federal regulations and assisted living facilities currently only have state regulations that vary widely from state to state. No matter what the site, the consultant pharmacist helps the facility stay current with their healthcare practices to ensure proper regulatory compliance.
A drug information resource
Consultant pharmacists are skilled at searching the medical and pharmacy literature, answering specific drug information requests, providing individual patient drug therapy assessment, and advising the facility staff of the proper methods of storage and administration of drug products. The consultant pharmacist is the leader in providing the most current evidence-based medication information to other health care providers in the long-term care setting.
A problem solver
Consultant pharmacists participate in solving the many problems that commonly arise in modern health care environments. It is easy to identify and list problems, but the consultant pharmacist takes the next step to recommend solutions or strategies to solve these problems facing the facility. For example, nursing staff often approach the consultant pharmacist with requests to review individual patients with onset of new symptoms. The consultant pharmacist then looks at all the relative information to decipher if the cause could be medication related.
A management expert
The consultant pharmacist manages people, policies and procedures, drug distribution systems and a variety of other functions that require effective management skills.
An effective consultant pharmacist is not limited by convention and is effective at developing new ideas for systems and programs.
The consultant works in a competitive health care environment and provides services with an emphasis on quality of care. For example, many ASCP members have implemented their consultant services in senior centers, physicians offices, and other areas of the community. More examples of innovative practices within ASCP membership are available.
A business leader
Business skills, such as marketing and customer service are essential for the consultant pharmacist. Whether working for a company or starting one’s own business, these business skills are necessary.
Once the essential core skills are developed, the consultant can then begin to provide the services that are both recognized and valued by patients and facilities. These include:
In addition, it is as important to continue to provide other information and education services. These could include:
Do you have what it takes to be a consultant pharmacist?
Maybe you feel a little shaky in one or more of the areas discussed. If you have the right attitude, and willingness to take the plunge, ASCP has the resources to bring you up to speed in the areas where you may need help.
Consultant pharmacy practice does not require a particular academic degree. However, because of the clinical nature of the practice, an extensive understanding of geriatrics, geriatric pharmacotherapy, and the unique medication-related needs of the elderly is crucial to ensuring the most beneficial care. The settings where consultant pharmacists are most numerous -- nursing homes and assisted living -- are dominated by older adults. For these reasons, knowledge of geriatric pharmacotherapy is a basic prerequisite to working as a consultant and senior care pharmacist.
ASCP has established Practice Resources that link to a wide variety of resources on geriatric pharmacotherapy, including practice guidelines, and other clinical information.
ASCP also has a Web page on Medication-Related Problems in Older Adults, with an extensive bibliography and information about polypharmacy, use of inappropriate medications, undertreatment of conditions in older adults, and other types of medication-related problems.
The Senior Care Online University for Professionals -- SCOUP -- is another ASCP Web site with free continuing education programs for pharmacists. These educational programs focus on issues related to older adults, such as pain management, depression, and osteoporosis.
The Commission for Certification in Geriatric Pharmacy (CCGP) has a Web site with information about becoming a Certified Geriatric Pharmacist (CGP). The Commission offers an examination in geriatric pharmacotherapy. More than 1,300 pharmacists have successfully completed the examination and become CGPs. By becoming a CGP, along with receiving extensive geriatric training, professional and personal opportunities will expand and further develop and expand the practice of pharmacy for the benefit of America’s aging population.
To help prepare for the CCGP examination, or just to learn the basics of geriatric pharmacotherapy, ASCP has developed the most comprehensive learning site for pharmacists, GeriatricPharmacyReview.com. This Web site allows for self-study and self-assessment of knowledge and is readily available 24/7. This Web site requires a fee to register, and offers twenty modules on geriatric pharmacotherapy. It is well worth checking out!
ASCP periodically publishes supplements to accompany The Consultant Pharmacist, ASCP’s peer-reviewed monthly journal. Each supplement is focused on a specific subject or theme related to geriatric health care.
ASCP also sponsors a list server, the Geriatric Pharmacotherapy email discussion group, which is available to any geriatric health care provider who wishes to join. Over 600 pharmacists, physicians, nurse practitioners, and academicians are currently enrolled. Enrollees can post questions and get input from other group members on specific clinical issues or tough cases. To subscribe, visit List Servers.
Additionally, ASCP sponsors 12 other list servers that represent various special interest groups. One of these, the Senior Care Pharmacist Forum is for those members who are providing consulting services to seniors in community settings outside of nursing facilities. This provides a great venue to learn of new and innovative areas where pharmacists can expand or develop their practice! To subscribe, visit List Servers.
Settings Served by Consultant and Senior Care Pharmacists
The roles and practice environments for consultant and senior care pharmacists today have progressed far beyond what the most optimistic consultant pharmacist would have predicted 20 years ago. The most innovative consultants are providing advanced services including disease management protocols, software development, laboratory services, nutrition services, and clinical research to a number of different settings.
Elderly patients are an especially important focus of consultant and senior care pharmacy practice, not only because of their rapidly growing numbers, but also because they are more likely to suffer from medication-related problems such as adverse drug events, drug interactions, excessive use of medications, and inappropriate and duplicative drug therapy. Because of this, the practice of consultant and senior care pharmacy cannot be restricted to the elderly living in institutional settings such as nursing facilities or assisted living facilities. The quality of care and services provided by consultant and senior care pharmacists must be provided to seniors wherever they reside, including those living in the community.
Below are examples of practice settings served by consultant and senior care pharmacists:
• Acute care hospitals
• Adult day care centers
• Alcohol/drug rehabilitation centers
• Ambulatory care/surgical care centers
• Area Agencies on Aging
• Assisted living communities
• Community pharmacies
• Correctional institutions
• Home health agencies
• Intermediate care facilities for the developmentally disabled
• Life care facilities
• Naturally occurring retirement communities
• Nursing facilities
• Physician’s offices
• Residential care/board and care homes
• Senior centers
• Subacute care facilities
• VA hospitals
For those pharmacists who consult to institutions, such as nursing homes, assisted living, or correctional facilities, they must focus on two broad issues:
• Resident- or patient-focused activities, such as drug regimen review
• Facility-focused activities, such as establishing policies and procedures for medication use
In the first case, the focus is on ensuring that the resident is receiving appropriate drug therapy and monitoring. In the second case, the focus is on assisting the facility with providing optimum care to all the residents in the facility, as well as helping the facility stay in compliance with federal and state regulations and guidelines. Resident-focused activities require primarily clinical skills. The facility-focused activities require administrative skills and knowledge of issues relating to medication acquisition, storage, administration, and disposition.
Clinical skills and knowledge of geriatric pharmacotherapy apply to all seniors in a wide variety of settings. Once these skills are obtained, they can be applied in different environments. However, the facility-focused activities are often unique to each setting or, at the very least, require very different applications.
Nursing Facility Consulting
Nursing facilities were the training ground for today’s consultant pharmacists, and they still represent a great opportunity. Federal law requires nursing facilities to have a pharmacist conduct drug regimen review on every resident in the facility at least monthly, along with other specified duties.
Knowledge of nursing home regulations is essential for the consultant pharmacist. Check out Nursing Facility Survey & Regulations for comprehensive information and links regarding regulations for nursing facilities, including information about the State Operations Manual and the Minimum Data Set (MDS). The MDS is the comprehensive assessment instrument that is required for use on all nursing facility residents. This document is the basis for the development of the resident care plan and is also the basis for payment for Medicare Part A residents.
In addition, ASCP has information on the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) which authorized the Medicare Part D drug benefit. Check out the Medicare Drug Benefit Briefing Room for resources and links to assist you, including access to the actual legislation and to ASCP's numerous official letters of comment, issue papers and briefs, and special bulletins.
ASCP's professional policy statements and practice guidelines are intended to help pharmacists provide pharmaceutical care services and to help educate other stakeholders about consultant and senior care pharmacy issues. Check out the ASCP Policies page for both policy statements and practice guidelines, plus official ASCP comments documents, issue papers, and more. A sample list of some of these documents is provided below to whet your further exploration:
• Assessing Quality of DRR in LTC Facilities
• Counseling Geriatric Patients
• Documenting Pharmacists' Activities in the Medical Record
• Formularies in Nursing Facilities
• Formulary Principles for Older Adults
• Infection Control, Role of the Consultant Pharmacist in Long-Term Care Facilities
• Mandatory Tablet Splitting for Cost Containment
• Medication Errors, Preventing, in Pharmacies and Long-Term Care Facilities through Reporting and Evaluation
• Nursing Facilities, Consultant Pharmacists Serving
• Psychotherapeutic Medication Use in Older Adults Subacute Care, Providing Consultant and Dispensing Services
• Return and Reuse of Medeication in Long-Term Care Facilities
• Separation of Providers and Consultants
ASCP has a variety of products to assist consultant and senior care pharmacists. Check out the products listed below at the ASCP online store .
Getting started in consultant pharmacy, especially for the new consultant, is an exciting and large endeavor. ASCP understands the needs of new consultant pharmacists and has developed a great package deal on resources that new consultants need to get started. Check out the “ASCP - Getting Started in Consultant Pharmacy Practice Kit ” in our bookstore. It will provide you with the products needed to get your practice moving.
Assisted Living Consulting
Assisted living is an emerging opportunity for consultant pharmacists. This field is rapidly growing, but does not presently have federal regulations or oversight. It is regulated at the state level, and state laws and regulations vary widely. Check out ASCP’s Assisted Living Briefing Room for a wealth of information about consulting to assisted living. Check out ASCP's Medication management in Assisted Living Report and Medication Policy and Procedure Manual for Assisted Living and other products at ASCP - Assisted Living . These references and resources are tools for pharmacists to develop their practices in the assisted living field.
Consulting to Other Settings
ASCP members serve as consultants in a wide variety of other settings. ASCP has established a number of ASCP member email list server discussion groups to enable networking of members who serve in some of these alternative settings. List servers are currently established for these groups:
• Academic-based Geriatric Pharmacists
• Ambulatory Surgical Centers
• Assisted Living Facilities
• Correctional Facilities
• Home Health
• Intermediate Care Facilities/Mentally Retarded (ICF/MR)
• Independent Consultant Pharmacists
• Pharmacy Owners and Managers
• Veterans Affairs