Pharmaceutical services for skilled nursing facilities in compliance with federal regulations.

A program of providing dispensing, clinical and administrative pharmaceutical services to three skilled nursing facilities is described. Medications are provided to patients from a community pharmacy through a centralized unit dose drug distribution system. Features of the system include pharmacy review of the physician's original order, medication histories obtained by a pharmacist, patient medication profiles, and a 24-hour exchange of drug cabinets containing individual patient drawers. The time requirements for administrative and clinical functions, and the calculation of a fee for these services, are described. Over a four-year period, the average number of medications per patient was reduced from 7.7 to 6.1. Two factors believed to be related to this reduction are an effective automatic stop order policy and careful review of patient medication profiles by the pharmacist.