Position Statement On Physician-Consultant Pharmacist Roles And Collaboration In The Nursing Home

RESOLUTION A07

THEREFORE BE IT RESOLVED THAT, AMDA supports the following positions:

• Collaboration among attending physicians, medical directors, and consultant pharmacists to promote improved care quality in nursing homes is desirable and feasible;
• Attending physicians, medical directors, and consultant pharmacists should familiarize themselves with the care process and with their complementary roles in that process;
• Physicians and consultant pharmacists should recognize that both disciplines have the patient and the care process as a common basis for their roles;
• In each facility, the medical director and consultant pharmacist, along with the attending physicians, administrator and other key clinical leadership, should collaborate to establish or reaffirm policies and processes related to the effective ordering, storage, administration, monitoring, and management of medications;
• Each facility should ensure that those of all direct care disciplines, within the scope of their training, recognize the risks as well as the benefits of medications, and understand the proper processes for making decisions about the need for medications, in order to help provide information about symptoms and condition changes in specific residents that may relate to the benefits and adverse consequences of medications;
• The physician has the ultimate responsibility to determine the need and desired therapeutic goals for medications;
• The consultant pharmacist provides valuable input and support regarding diverse aspects of medications, which physicians should utilize effectively in making decisions about medication utilization in their patients;
• Facilities should establish policies to identify those disciplines (physicians, midlevel practitioners, consultant pharmacists, and any other health care practitioners), that are permitted to make recommendations regarding medications, and should inhibit other unauthorized individuals from requesting the physician to order specific medications or from recommending to nurses that they ask physicians to do so;
• Both consultant pharmacists and physicians should recognize the importance of sufficiently detailed, pertinent recommendations and responses concerning medication utilization and the medication regimen review processes;
• Both physicians and consultant pharmacists should recognize and incorporate key considerations into their thinking about medications, including current knowledge of the benefits and adverse consequences of specific medications;
• Both attending physicians and consultant pharmacists should share responsibility with nursing staff and others to try to prevent, anticipate, identify, and address adverse consequences related to medications, and should focus on the judicious use of any additional medications and health care services to address symptoms that are due to existing medications in the patient's regimen;
• Physicians and consultant pharmacists should collaborate to promote a proper care process in all nursing facilities, because of the importance of adequately detailed and accurate information in helping correctly identify causes of symptoms and avoid unnecessary medications;
• Physicians and consultant pharmacists should collaborate to reconcile cost and clinical considerations in relation to medication utilization, and to promote a more efficient and clinically conscious approach to documentation required for drug authorization and exceptions; and
• In each facility, the medical director and consultant pharmacist should establish a collaborative relationship to address issues and concerns regarding medication utilization, consultative recommendations, and physician responses to those recommendations.