Long-Term Acute Care Hospitals

[baronzb]

Are these long-term care, skilled nursing facilities or actual inpatient hospital facilities? There is one run by a national corporation independently in a larger public hospital. Is this considered an inpatient pharmacist job that would be respected and honored as experience by hospital pharmacy employers? (I'm trying to keep hospital skills intact and gain new resume experience.)

What kind of patient care and modalities are seen? How is it more narrowly focused clinically than a regular inpatient hospital? How clinical can this be made to be?

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[DaftRx]

I started as a director of an LTACH about 6 months ago through a pharmacy management staffing company. It sounds like what you are looking at is set up the same way mine is.

Firstly, it is an inpatient facility. It’s a separately licensed hospital within another hospital. Mine takes up one small wing (about 20 beds). Usually, the LTACHs are for profit, while the hospitals are not. I work in the same space as the hospital pharmacy, but my stock is kept separate due to different licenses.

Our average patient stay is 3-4 weeks. We see a wide variety of cases. Mainly diagnoses requiring long term antibiotics (i.e. endocarditis), wound care patients, chronic respiratory failure situations, etc. You see less acute diagnoses.

In terms of how clinical, my time is 70/30 clinical to management. I round daily with my medical director and weekly with all other departments. I’m responsible for all vancomycin/aminoglycoside dosing and monitoring, dosing and maintaining tpns, monitoring lab values, interactions and so on. I am the only pharmacist for the ltach, so it’s pretty much everything across the board. The management portion is everything an actual director would be responsible for as well.

I’m technically also responsible for an antibiotic stewardship program, but my medical director is the lead ID physician for the hospital we are housed in, so there really isn’t a need.

It’s a decent gig. M-F 8-5. No weekends, holidays or on-call. I have 1/2 FTE of tech coverage from the hospital I’m in to help with iv’s and other tech responsibilities. Coverage after I leave is provided by the hospital as well.

I feel it would be a respected position. You would just have to communicate your responsibilities clearly.

 

[baronzb]

How about tech coverage? Seems the wknd rph is solo. 34 beds

 

[DaftRx]

I had a dedicated tech for 8 hours a day that was employed by the larger hospital I’m located in. In an effort to reduce costs, I cut it to 1/2 FTE and merged my workflow for the LTACH with the larger hospital. It helped my bottom line and helped the larger hospital staff by utilizing their tech better. The LTACH workload was never close to 8 hours anyway for that tech (lots of down time).

With 34 beds I’d expect at least 1.5-2 FTE’s for techs. That would give good coverage throughout the day for any variety of duties.

The thing with LTAC is that there isn’t a lot of change in patients. Sure, they may acquire an infection, kidney function may change requiring redosing or they may go critical, but in my experience, nothing is really a big surprise. You are monitoring these patients for weeks on end. You can establish trends and have a wealth of data on any particular patient. You can really learn to predict which direction they are going.

With that in mind, you can batch a lot of ivs and not be worried about having to waste them. Some of my iv antibiotics have stop dates that are 42 days out. I usually prepare at least 48 hours of meds that way if the larger hospital I’m in has a bad weekend, they don’t have to worry about my stuff because they are thin on the weekend too.

What I’m trying to say is that if you work it right, flying solo on a weekend wouldn’t be a big deal. So long as they don’t admit someone late on a Friday for whom you can’t prep for or don’t have any info on.

I don’t work weekends because I truly don’t need to. On average, the pharmacist from the larger hospital only bills me 2-3 hours of their time over the weekend because eveything has already been done for them. It’s just minor changes that need to be addressed.

It also helps that my medical director rarely works weekends. So the MDs that cover for him are really only interested in keeping the patient from getting worse. They don’t make many changes unless they absolutely have to.