Pharmacists onsite at Jewish Home’s skilled nursing facility provide immediate care


Embedded pharmacists review charts, counsel patients, optimize therapy

In hospitals and health systems across the country, pharmacists are becoming increasingly integrated into patient care by rounding with medical teams, providing medication counseling at various points along the transitions-of-care continuum, and developing strong inpatient−outpatient collaborations. The Los Angeles Jewish Home has taken an innovative approach to improving patient care by building an onsite pharmacy located within its skilled nursing facility.


Pharmacy services


“It’s not unusual for a pharmacy to be located within a hospital, but it is unusual for a full-service pharmacy to be located within a skilled nursing facility,” said Robert Shmaeff, BSPharm, MPA/MHSA, Director of the Pharmacy. 
The skilled nursing facility at the Jewish Home is a 249-bed facility, including 10 beds for patients with acute geriatric psych needs, such as uncontrolled bipolar disorder, schizophrenia, depression, and dementia with behavioral disturbances.

Psychoactive medications in particular can be problematic in geriatric patients, he added, and the facility is trying to mitigate the potential adverse effects of polypharmacy. 
Along with a team of clinical pharmacists, pharmacy technicians, and pharmacy residents, “we review every chart of the people [who] go through the psychiatric ward and make recommendations to the physicians,” Shmaeff said. “We’re on hand to talk to other health care providers like physicians and nurses about lab tests, potential adverse effects, medication allergies, and optimal doses,” he added. 


Faster care


Shmaeff joined the skilled nursing facility in May 2008. Since then, Shmaeff has observed a remarkable improvement in being able to provide patients with faster pharmacy services. Before, medication orders and other pharmacy-related issues had to be routed through an outside contracted pharmacy, and long delays in receiving medications were common. But with a pharmacy located onsite, pharmacists provide immediate care to all the patients, including monitoring routine medications and monitoring and adjusting warfarin. 
Shmaeff explained that the pharmacists go to the patient beds and talk to the patients and their families or caregivers. They provide discharge counseling to the patients upon leaving the psychiatry unit or explain complex medication regimens and potential adverse effects to their families or caregivers.



Director of Pharmacy Robert Shmaeff, BSPharm, MPA/MHSA, and pharmacy resident Kimberly Appleby, PharmD, inspect a medication before it is delivered to a skilled nursing resident.


The pharmacists at the skilled nursing facility also collaborate with physicians, nurses, and other health care providers. For example, the pharmacy resident participates in interdisciplinary care teams at the geriatric psychiatry unit and the Brandman Centers for Senior Care to ensure safe and evidence-driven pharmaceutical care. Multiple medical disciplines sit in on these meetings to meet the complete needs of the patient. Shmaeff pointed out that the pharmacist’s participation in these meetings has been successful in reducing unnecessary medications and simplifying medication regimens when multiple medications are onboard to treat the same condition. 


Residency program


Recently, the Jewish Home pharmacy was accredited by the American Society of Health-System Pharmacists for postgraduate training. Residents who successfully complete the Jewish Home/Western University residency are exposed to multiple practice sites unique to geriatric care. They also complete a yearlong research project and earn a teaching certificate through Western University after giving lectures and precepting pharmacy school students.

The resident also sits on interdisciplinary care teams to optimize patient care through safe and effective pharmaceutical care. 
The current resident, Kimberly Appleby, PharmD, helped launch a pilot program aimed at delivering pharmacist-directed anticoagulation to the skilled nursing residents. 
For Shmaeff, whose background is in hospital pharmacy, working in a skilled nursing facility is incredibly rewarding. “We’re there, we’re onsite, and there is no delay in the delivery of care or medications,” he said. “We’re right there to answer questions from the patients and the medical staff.”