Contract Company Pharmacy Run LTAC

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I'm transitioning from clinical floor job to ltac manager, as a spring board. i have some management experience, but i know, and read that ltac is not real hospital. This job is also through a contract company, meaning that they dont own the pharmacy and only run it on contract. given the nastiness of USA job politics, i am wondering how precarious this job may be. how easy it is for the ltac staff i will be working with to screw up or complain and how itchy cardinal would be to can me upon such complaints.
on the plus side this looks like an easy mangement site, no critical care, only the simplest of IVs, etc. I would want to transition back to critical care hospital at some point as a manager of operations.

Thanks you, only replies of people with direct or indirect experience, as this post is to solicit advice.

 

[Rockinacoustic]

Posting in a clarkbar thread

 

[RxPreceptor]

😂 I swear we are up to like a dozen of these ask for advise, playing out various work scenario posts from OP
Overthinking and self induced anxieties of playing what if for waaaay too long

 

[clarkbar]

This is a serious question that is also important for everyone on the forum, including retail people, as small LTACs and Rehab Hospitals are retail friendly.

Looking for advice for me and as a proxy for others. Thank you for your support.

 

[PharmDBro2017]

Cardinal is a decent company and gives good guidance for SOPs, regulatory compliance with USP, telepharmacy for overnight continuity of care, etc. A lot of the job will depend on your cardinal boss + hospital ceo though, and if they are cool or not.

Your impression of LTAC not being a hospital is wrong, and most people wouldn't know until they worked in that setting. Most LTACs depend on highly acute critical care patients with heavy DRG to bring in $, these are often mechanically ventilated patients that require 25 day+ length of stay, or have failed vent weaning at STAC hospitals. ICU is typically small, 1-20 beds, and majority of other patients are medsurg + wound care, but they have many chronic comorbidities and are on 10-20 medications... they are pretty complex. Every LTAC is different, but most of them fit this framework. If yours doesn't do much critical care and only simple IVs, that sounds pretty chill.

Previous LTAC I worked at had multiple patients on versed, fentanyl, precedex, pressors, the occasional vecuronium drip, and often 1 to 5 TPN patients. Combo that with many vanc/aminoglycoside consults... there was a lot to do clinically each day. If you have a sterile compounding/usp 797 compliant room, it can be a lot of work.

 

[clarkbar]

Thank you for your informed response.
In my impression, the LTAC patients, though acute, are not critical and have been worked up by ICU to the point where they are on fairly iron d/c med regimens, eg., osteo for several weeks or ortho surgery for 1 month vanc, etc. This leaves little room for abx, which is about 50 percent of critical care pharm.
I was thinking of following, BG, sleep, pain, anticoag, renal, IV-PO, not sure what else. These patients don't seem to have a high turnover, also causing problems for opportunities.

 

[Rouelle]

Thank you for your informed response.
In my impression, the LTAC patients, though acute, are not critical and have been worked up by ICU to the point where they are on fairly iron d/c med regimens, eg., osteo for several weeks or ortho surgery for 1 month vanc, etc. This leaves little room for abx, which is about 50 percent of critical care pharm.
I was thinking of following, BG, sleep, pain, anticoag, renal, IV-PO, not sure what else. These patients don't seem to have a high turnover, also causing problems for opportunities.

I spent 6-7 years as an LTACH pharmacist. Based on my experience at that particular location, I would say that your expectations are grossly inaccurate. You should expect lots of critical drips (sedation, cardiac, etc). Easily more than half the antibiotics were started in the facility, as opposed to inheriting them from the referring hospital. Expect to respond to codes regularly. Lots of vents, HD patients, TPN, etc. Gone are the days when LTACHs will admit people for 3-4 weeks of wound care. There are much more profitable diagnosis codes out there.

Sleep, pain, etc…you’ll see those meds but they are a minor thing for you. Yes, you should expect renal dose adjustments, IV-PO, etc. Often, LTACH MDs are contract folks, not LTACH employees. They’ll sweep in every day, round, and leave. Often, you’ll be the most clinical person on site, so you’ll get a lot of questions from nursing if they trust you.