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Long Term Care Delivery / Back-up Pharmacy Services Q&A | Kevin R. Fearson, R.Ph, MBA, FASCP, President ASCP

Q. Does Absolute Pharmacy use a delivery service or backup services? Why?

Absolute Pharmacy is open 24/7 so most stat deliveries are fulfilled in-house at our pharmacy. We do have an extensive network of retail, institution, and hospital pharmacies that are used as needed to fulfill orders that are urgent, backordered drugs, and/ or unplanned events. Our private delivery service coordinates all of the pick-up and drop off activities. Our system provides layers of redundancy and extends our internal resources to be in the strongest position to always provide medication timely.

Q. What are the benefits of having delivery/ backup services implemented?

The benefits of a backup network is that it provides depth to a pharmacy’s ability to provide medications regardless of the timing or product requested. The pharmacy has many methods to ensure delivery, including if a facility is in need of medication quickly because of medical, survey, or family concerns, having a backup pharmacy that could be 10 minutes away from a nursing facility but two hours away from the pharmacy allows a faster turnaround time. Another example is if weather shuts down roads, having something proximate to the facility facilitates easier and efficient delivery.

Q. Does your pharmacy have software to permanently store an electronic delivery manifest on a real-time basis?

There are many benefits of software that immediately notifies the pharmacy of delivery and is retrievable by date, Rx #, and location of delivery in the event that a problem occurs. Caregivers and patients often are unaware or do not know the medication has been delivered and a confirmation to the pharmacy allows for management and assurance of the medication being available. Additionally, this record is very useful with pharmacy audits.

Q. How quickly is your back-up able to respond to a request?

Back-up pharmacies are just that — a back-up source. They have their own priorities and may not be able to complete the transaction in a timely manner. The end result could be a delay of the medication being delivered to the patient. Pharmacies need to carefully understand the waiting and delivery times before selecting a back-up service.

Q. Have you taken into consideration that senior pharmacies have special formularies that retailers might not have?

Senior drug usage often uses specialized drugs such as liquids, low dosage, or uncommon inventory. Back-up pharmacies many times do not have these geriatric or unusual dosage forms in stock. We typically prefer high-volume pharmacies that have a robust inventory. Pharmacies may need to have a plan on how to remedy locating senior medications from a reliable supplier.

Q. Will I receive unusual requests from nursing facilities to special deliver medication?

Nursing facilities are often busy places, where care is handed off to other nurses, agencies, both overworked and understaffed. You should anticipate emergency requests for refills, OTC, and non-urgent orders. The nurses are under regulatory compliance pressure, family expectations, and management rules. You will need to understand the expectations so that there is satisfaction at both ends. It’s so important to be a consummate educator and problem solver as the stream of requests occur. 

Q. What are common drugs or emergencies that need to be expressed to the LTC?

Pain medications are difficult to coordinate legal requirements with any third party, so the pharmacy needs to have a method of providing control drugs. New admissions are common requests by facilities that need to have medications immediately available. Antibiotics, hypertension, NSAID, allergy, and other irritable conditions affecting a person’s comfort, are also common requests and should be anticipated.

Q. Who pays for the expensive delivery?

This is a difficult problem — no one wants to pay. The nursing facilities goal is to have medication available. Pharmacies need to be prepared to incur the delivery cost and pre-arrange the financial expense.

Q. What about security and reliability of unknown drivers picking up medications and having access to healthcare settings?

We prefer delivery services that concentrate on healthcare and are trained in procedures. Our drivers are assigned to our routes and locations and get to know our facilities. They become an extension of the pharmacy. We have tracking methods that allow us to know where the driver and medication are in terms of location and delivery status. The drivers have a dress code that helps facilities recognize them.

Q. A hybrid approach to a delivery service is more robust, controls costs, and often is the quickest method of delivery. Can you elaborate on what this model could look like?

A hybrid model has multiple layers. The first layer is 24/7 availability. We do not use an answering service so phone calls and requests are received by employees at any time or day (inclusive of holidays). Being a 24/7 pharmacy, delivery of most stat medications will come directly from the pharmacy.

The second layer is a good emergency kit system located at the facility. The kit should be regularly updated with the facility’s most common medications and checked for stock and valid expiration dates. Medication storage can be in well-designed plastic boxes or in electronic cabinets that interface with the pharmacy. Lastly, use the backup service network as needed if the other two resources cannot fulfill a medication need.

Q. What about using electronic cabinets?

There are many cabinets on the market and varying degrees of functionality and price. They usually are subject to regulations on contents, security, and process. They are expensive but do offer immediate patient medication availability. The higher-end cabinets are interfaced with the pharmacy to grant access to medications, matching patient profiles, billing, and replenishment with each transaction. Work with vendors to finance and learn more about their applications.

Q. How do you see LTC delivery and back-up pharmacy services evolving in the future?

I think technology will continue to evolve and “smart kits” will predominate the industry. Electronic Health Record system should help the industry transfer information seamlessly to help providers have more accurate information on a real-time basis and avoid gaps of med availability. I see e-mars populating and synching the supplies with pharmacy and medication orders being sent on a “just-in-time” basis.

headshot_kevinfearon.jpegKevin R. Fearon, R.Ph., MBA, FASCP, President ASCP

Throughout his career, Fearon has acquired broad pharmacy experience, having spent the past 35 years in LTC. Beginning in hospital and transitioning to retail and institutional practices, Fearon has held national leadership positions for over 15 years, enabling him to develop best practices while interacting with boards of pharmacy and automation companies. Fearon’s experiences with best practices, software, and automation influenced the industry’s use of regulatory changes and technology, along with the adoption and modification of dispensing practices. Fearon is a graduate of The Ohio State College of Pharmacy and obtained an MBA from Baldwin Wallace University. He is the current president of ASCP.

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