A consultant pharmacist? What are they consulting on? If you’ve already read “What Does Your Pharmacist Actually Do All Day?” written by Megan Holland, you know the numerous things that pharmacists do while working in a pharmacy.  Consultant pharmacists often do not work in a dispensing pharmacy; they work in a variety of healthcare settings and provide clinical guidance on safe and appropriate medication use.

My job as a consultant pharmacist is specific to long-term care, but consultant pharmacists can also work in assisted living facilities, surgical centers, mental health facilities, correctional facilities, hospice settings, and more. The main duty that all consultants have regardless of the setting is performing medication regimen reviews (“chart reviews”), which involve clinically evaluating all aspects of medication therapy for each patient in the facility.  We also collaborate with nursing staff and physicians to optimize medication therapy (including tapering medications), verify that medications are being given and stored appropriately, and ensure that regulations are being followed. Every day brings new challenges!

The majority of my job involves conducting chart reviews. I first begin by accessing each patient’s chart, as well as our own notes in the consulting system/pharmacy system, to look at medication history. After a comprehensive review of medications, we check other aspects of the chart such as lab work, nursing and physician notes, vaccinations, vitals, etc. This gives us a complete picture of the patient’s health so we can optimize therapy and make recommendations such as: lowering medication doses for decreased kidney function; increasing diabetes medications if blood sugars are elevated; discontinuing medications if they pose a risk to the patient; requesting lab monitoring; changing medications if a safer or more cost-effective option is available; and much more! Since I work specifically in a long-term care setting that cares for older adults, we also employ our specialized geriatric medication knowledge and commitment to patient-centered care when reviewing charts. Once each patient’s chart has been fully assessed, we collaborate with the attending physician to make recommendations. The physician can either agree or disagree with our recommendation, which then leads to further conversation.

In addition to medication regimen reviews, we also make our rounds at the skilled nursing facilities to audit controlled substance medications, verify that medications are being administered to residents appropriately (before, with, or after food; “do not crush” medications; appropriate inhaler or eye drop technique; etc.), and address any concerns with nursing staff. This aspect is one of my favorites because I enjoy the collaborative care between pharmacy and nursing. While at the facility, getting to interact with the residents is a nice perk too! Many consultant pharmacists also provide education to the facility staff, develop medication-related policies and procedures, assist with quality assurance and compliance, and take part in a variety of clinical projects. At our pharmacy, this aspect of the job is handled by our Director of Clinical Services.

While I am not a full-time consultant pharmacist, it is my favorite component of my job as a pharmacist; I spend about 40% of my time consulting and 60% staffing the pharmacy. It’s nice to have a foot in both doors and be a liaison between the two settings. I find consulting to be especially rewarding because I enjoy applying my clinical knowledge and knowing that I’m making a difference in patients’ lives. Being a part of the healthcare team brings me great joy.

Written by: Kyle Dolan, Pharm.D.