SPOKANE, WASH. – On October 10 Britne Wakem spoke to Washington State University (WSU) College of Pharmacy and Pharmaceutical Sciences (CPPS) students about pharmacy consulting in a long-term care facility. Pharmacy consulting is when a pharmacist, such as Britne Wakem, is hired to give their expert advice on the use of medication or pharmacy services to an individual or organization on a consulting basis (as opposed to as a full-time employee).

Wakem has worked for Fred Meyer since 2008, first as a pharmacy assistant/intern then as a staff pharmacist since receiving her Doctor of Pharmacy from WSU in 2015. She has consulted for the Washington State Department of Veterans Affairs (WDVA) since 2017. In her role, she works with WDVA sites, including the Washington Veterans Home, Washington Soldiers Home, Spokane Veterans Home, and the Washington State Walla Walla Veterans Home. Wakem primarily spends her time at the Washington Veterans home, which is the largest long-term care facility in the state, housing 240 veterans. As a consultant pharmacist Wakem looks over charts, analyzes antibiotics, and educates facility staff on medications and regulations.

WDVA sites go through an annual survey to keep their accreditation, and recently the rules changed. The Centers for Medicare and Medicaid Services (CMS) which governs care facilities made significant changes to their regulations, this change is referred to as the CMS Mega Rule. The CMS Mega Rule changed practice from a specific medication review (where pharmacists only reviewed what medications a patient was taking) to an overall chart review for patients, so it now includes a review of all aspects of care (including diet, exercise, and the patient’s lifestyle as a whole). Part of this change included changes to the federal CMS regulations, called F-tags. Wakem discussed one F-tag that particularly affects her work: F329.

F329 addresses drugs which are considered unnecessary for the patient. F329 defines “unnecessary drugs,” as a medication with an excessive dose or duration, inadequate monitoring or indication and/or adverse consequences. An excess dose or duration may be a medication that has no specified end date in the patient’s file. Inadequate monitoring or indication is when a medication may no longer be necessary based on the patient’s circumstances. Adverse consequences refer to when the negative effects outweigh the benefits of the medication. For example, medication therapies used to treat mental illness increase mortality in geriatric patients and raises a question of necessity in some cases.

Additionally, symptoms reduce over time and with age, Wakem explained. Part of her review for unnecessary drugs may include gradual dose reductions (GDR).

“A patient may be prescribed a medication for impulse control because they are hitting, and five years later that patient is bed-ridden and the medication no longer needed,” Wakem said. “Providers have to have justification for overwriting the original criteria. Your job as a consultant pharmacist is to keep facilities in compliance with [F-tag] regulations.”

Wakem also showcased the newest WDVACPPS Doctor of Pharmacy rotation at the Retsil Washington Veterans Home in Port Orchard, Washington. Fourth-year CPPS Doctor of Pharmacy students participate in Advanced Pharmacy Practice Experience (APPE) rotations to gain experience working with actual patients in real-world situations. These rotations are completed at practice sites where students work under the supervision of a WSU preceptor, such as Britne Wakem at the WDVA.

During Wakem’s time as a student, the only long-term care rotation option was in Spokane, and being from western Washington she wished there were more options closer to home. The new pharmacy rotation, which Wakem helped to create, is meant for student pharmacists interested in geriatric specific long-term care. The rotation is part of the CPPS residency block scheduling, which allows student pharmacists to complete the majority of their rotations at a single setting. The rotation consists of two, twelve-week back-to-back blocks for institutional or ambulatory care and gives students the opportunity to function as a clinical consultant pharmacist. Wakem emphasized the student’s ability to customize his/her learning during the rotation.

“Each person takes their own focus while learning to be a consultant pharmacist as a whole,” she said.

Wakem’s seminar was part of the college’s Preparing for Your Career in Pharmacy Seminar Series. The purpose of the series is to introduce student pharmacists to career opportunities and leaders in the pharmacy profession. The seminars are funded through the WSU CPPS Dean’s Fund for Excellence and our community partner, the Spokane Teachers Credit Union. For information on participating in the career seminar series, or to contribute to the Dean’s Fund for Excellence to help expose WSU student pharmacists to thought-leaders and industry innovators, contact the CPPS advancement office at gocougs@pharmacy.wsu.edu or 509-358-7651.