The Other Side of the Opioid Debate: Treating Older Adults With Chronic Pain.

Prescriptions for opioids and opioid-related overdoses have been on the rise-and in the news-in the United States for more than a decade. New guidelines and legislation related to opioid prescribing provide clinical challenges for many pharmacists and prescribers, particularly in the treatment of older adults with chronic pain. Careful patient selection, along with proper opioid dosing and monitoring, enables the pharmacist and prescriber to continue to treat the older adult with pain effectively.

Getting Paid for Clinical Services.

Increasingly, pharmacists are providing advanced, patient-centered clinical services. However, pharmacists are not currently included in key sections of the Social Security Act, which determines eligibility to bill and be reimbursed by Medicare. Many state and private health plans also cite the omission from Medicare as the rationale for excluding reimbursement of pharmacists for clinical services. This has prompted forward-thinking pharmacists to seek opportunities for reimbursement in other ways, allowing them to provide value to the health care system, while carving out unique niches for pharmacists to care for patients.

Antibiotic Stewardship in Long-Term Care: A Call to Action.

The Centers for Medicare & Medicaid Services and the Centers for Disease Control and Prevention are focused heavily on curbing the misuse of antibiotics in health care facilities. Regulations governing the management of antibiotics in the nursing facility will likely be changing in the near future, which will put the pharmacist at the forefront of a clinical team that is dedicated to proper antibiotic utilization. Savvy pharmacists are embracing this opportunity to engage long-term care facility staff to improve the care of their residents.

Implementing an Antimicrobial Stewardship Program.

The Centers for Medicare & Medicaid Services is expected to expand requirements for antimicrobial stewardship in nursing facilities during 2016. Many facilities are looking to pharmacists to help them take the initial steps toward developing these coordinated programs to promote the appropriate use of antimicrobials.

Antibiotic Stewardship: New Frontier, Familiar Journey.

Recent changes in regulations by the Centers for Medicare & Medicaid Services require long-term care facilities to meet specific requirements on antibiotic stewardship, promoting the appropriate use of antibiotics and antimicrobials. The goal is to improve patient outcomes and decrease the spread of infections caused by multi-drug-resistant organisms. Consultant pharmacists can help facility personnel implement policies and procedures for effective antibiotic stewardship, assist prescribers and facility staff in understanding how to use the facility's antibiogram, find appropriate resources, and provide facility personnel with feedback on their antimicrobial stewardship efforts.

Implementing an Antimicrobial Stewardship Program.

The Centers for Medicare & Medicaid Services is expected to expand requirements for antimicrobial stewardship in nursing facilities during 2016. Many facilities are looking to pharmacists to help them take the initial steps toward developing these coordinated programs to promote the appropriate use of antimicrobials.

The Changing Landscape of Consultant Pharmacy Part 1 of 2.

A dramatic increase in the senior population, along with adjustments in reimbursement for health care services, is altering the landscape of consultant or senior care pharmacy. An increased focus on quality, rather than quantity of services, offers new opportunities and challenges for pharmacists and all members of the health care team. This article features the viewpoints of three leaders in senior care pharmacy, and their visions for the future of this dynamic profession.

Wound care basics for the pharmacist.

Elderly skin is prone to wounds as a result of age-related changes and comorbidities such as diabetes and vascular disease. Wound healing is a complex process that can become compromised, leading to the development of chronic, nonhealing wounds in a frail elderly patient. Pharmacists and other practitioners who care for the elderly should be attuned to the wound-healing process and to the types of medications and wound care products available to aid healing.

Recognizing and preventing medication administration errors.

Proper medication administration in the long-term care facility is vitally important, as many medications have specific administration parameters that are essential to their optimal efficacy. Pharmacists servicing long-term care facilities play an integral role in observing medication administration in the facility and educating facility staff on proper administration techniques. By being vigilant to potential problems, pharmacists can help ensure that facility residents receive their medications appropriately.

Avoiding errors during transitions of care: medication reconciliation.

When medication errors occur, they often are the result of discrepancies in medication information during transitions of care, i.e., moving the patient from one setting to another. Pharmacists can play an essential role in performing in-depth medication reconciliation, which promotes positive patient outcomes and decreases health care costs.

Entrepreneurs: leading the way to pharmacy's future.

Entrepreneurship has always been central to the practice of pharmacy. Whether opening a new retail store, setting up a unique clinic practice, or researching a novel therapy, pharmacists are continually looking forward and following their visions of how pharmacy can be part of a new direction in health care. In 2011, the American Society of Consultant Pharmacists (ASCP) Foundation--itself the product of entrepreneurship--awarded grants to three entrepreneurs who are seeking to establish a fee-for-service component of their senior care pharmacy practices in the community. The grant recipients, while differing in their approaches, share the common goal of providing safe, effective, and cost-justified medication therapy and education to ambulatory older adults.

MDS: valuable clinical data that can help improve medication therapy.

The Minimum Data Set is a nursing facility assessment tool whose use is mandated by the Centers for Medicare & Medicaid Services. Data collected by this tool provide valuable clinical information about nursing facility residents and can aid the consultant pharmacist in performing a more effective and efficient medication regimen review.

Benchmarking 2010: measuring long-term care and consultant pharmacy practice.

The American Society of Consultant Pharmacists, with support from the pharmacy management software company QS/1, has completed its 2010 survey to determine industry standards for long-term care pharmacy operations, consultant pharmacist practice, and the use of health information technology in the long-term care setting. The report presents data collected in this annual business benchmarking survey. Examples of data include gross profit margins of long-term care/closed-door pharmacies, pharmacists' salaries, prescription payer mix, consultant pharmacist productivity and contracting, and implementation of technology solutions such as ePrescribing, electronic medication administration records, electronic medical records, and automated dispensing.

Quality of care: giving facilities the data they want--and need.

All nursing facilities in the United States are required by the Centers for Medicare & Medicaid Services to maintain a quality assurance and assessment committee to discuss issues related to quality of care. Pharmacists participating in these committees need to ensure that these advisory groups have the data and pharmacy evaluations that can be used by the facility to improve medication use and overall quality of care.

There's no place like home: a pharmacist fills the need.

As both the number and complexity of patients receiving health care at home continues to increase, there is also a growing need for pharmacists to oversee these patients' medication regimens. This article describes the practice of one pharmacist whose skills in medication therapy management and patient counseling have carved out a unique niche caring for home health patients.

Off-label use of medications: innovative prescribing or risky business?

Off-label use of medication is common and can lead to innovations in the use of medicine to treat patients in unconventional ways. However, issues of increased health care costs, decreased reimbursement, and lack of clinical data to support off-label use, are concerns of practitioners and patients alike. By using their knowledge of medications and carefully examining the existing research, pharmacists can aid prescribers in appropriate off-label medication use.

Hypodermoclysis: renewed interest in an old technique.

Dehydration is a common problem in elderly patients, often resulting in hospitalization. Intravenous administration of fluids can correct dehydration but poses other risks and problems. Subcutaneous administration of fluids, termed hypodermoclysis, offers an alternative method for rehydrating patients, and it is beginning to gain favor among practitioners in the long-term care setting because of its ease of use and minimal risk of side effects.

Compounding pharmacy: old methods finding a new niche.

Pharmaceutical compounding-the process by which a pharmacist combines ingredients into a customized medication for an individual patient-has ancient roots, with popularity that has waxed and waned throughout history. Elderly individuals and other long-term care patients may be among those who need customized medications, so pharmacists should be aware of the current scope and regulations for compounded medications.

Intravenous medications in long-term care: a wake-up call for pharmacists.

Many facilities are increasing the use of intravenous (IV) medications in an effort to care for patients with more complex health care needs. The number of IV medications also is increasing, and these products are helping keep patients in nursing facilities from being hospitalized. While some pharmacists have been hesitant to expand their expertise to include IV medications, it is essential that they do so to ensure the safe and cost-effective use of these therapies.

The consultant pharmacist's expanded role in nutrition management.

Recent changes to the State Operations Manual have expanded the role of consultant pharmacists and other members of the interdisciplinary care team in nutrition management. The increased focus on assessing medications, diseases, and other issues pertinent to nutrition brings both increased opportunity and responsibility for consultant pharmacists serving long-term care facilities.