Contribution of the Consultant Pharmacist to Rational Drug Usage in the Long‐Term Care Facility *

In a rural 116‐bed skilled nursing facility, a study was made of the influence of a Consultant Pharmacist on drug usage over a one‐year period. Lines of communication were established with the six attending physicians by means of work rounds, telephone calls, and both official and unofficial memoranda. Daily pharmacy rounds were conducted with health‐care students and the nursing supervisor, who facilitated physician‐pharmacist communication. The physician‐nurse‐pharmacist team studied each patient's problems, the status of the therapeutic endpoint, and the need of and usage of each regularly scheduled or pro re nata (PRN) drug. Stop‐order and standing‐order protocols were developed. During the one‐year period, the number of regularly scheduled drugs per patient was reduced from 3.30 to 2.66 (19.4 percent decrease), and of PRN drugs from 3.92 to 2.12 (45.9 percent decrease). The overall reduction was from 7.22 to 4.78 drugs per patient (33.8 percent decrease). The most significant reduction was associated with the protocol and stop‐order discontinuances of routinely scheduled drugs, and with the duplicated orders for drugs to relieve pain, nausea, vomiting, diarrhea, colds and cough. Implications for optimal care of the patients, and for the economics of this federally‐mandated system of consultant pharmacists are discussed.