Pharmacy Implementation for Facilities

The Case for Using a Contracted Pharmacy for All Residents and Clients

There are various reasons of why a facility should promote and attempt to have most of their residents or clients use the contracted pharmacy.  Of course their should always be some exceptions such as mandatory mail order.  But, to ensure quality, facilities should strongly consider using the house pharmacy as much as possible.

Consistency

First of all, using a house pharmacy allows the facility to have consistency.  This is very important to the organization so that protocols and processes are consistent, for example in ordering medications.  Also, there are certain facility expectations or requests that could be addressed by using a house pharmacy as much as possible eliminating additional phone calls or trying to have the staff remember each pharmacies protocols and work flow processes.

Compliance

Secondly, using a house pharmacy can help the facility to stay in compliance.  Most states have certain rules and regulations that the facility must abide by to stay in compliance in addition to following their own policy and procedures.  For instance, a facility may require a controlled substance count be completed routinely.  The contracted pharmacy may provide them with paperwork or electronic means by which this can happen.

Offerings

Thirdly, using a house pharmacy will allow the facility to have access to the full offerings of the facility such as:

• Delivery services
• Compliance packaging
• Proactive refills
• Emergency and after hours services
• Medication Administration Records (MARs)
• Other required paperwork:
  • Controlled substance counting sheets
  • Psychotropic review
  • Physician orders
• Electronic records (eHRs and eMARs) which may be interfaced with the pharmacy
• Med carts
• Consulting services

Here are a few considerations:

If a resident decides not to use the house pharmacy, make sure that the pharmacy is able to fulfill all of the requirements listed above.  Have a list to give to them.  For example, if the facility uses bubble or blister packaging and the current pharmacy provides bottles.  Explain that bubble cards are required at the facility.

If resident desires to use an outside pharmacy, consider charging a fee.  The reason behind this is that using a non-house pharmacy is going to create additional work and effort from the staffs perspective.

MARS and eMARs / eHRs are strongly recommended to be provided by the dispensing pharmacy or manually entered by the facility due to the risk of error because all orders have to be duplicated and the dispensing pharmacy will most likely not share orders to the contracted pharmacy.  If the dispensing pharmacy does not provide a MAR, it will require a lot of unnecessary work for facility staff and in particular the nursing staff.  MAR Only situations are not recommended even if the pharmacy charges.