The consultant pharmacist and the physician in the nursing home: roles, relationships, and a recipe for success.

Nursing homes must provide sophisticated medical and personal care to a broad spectrum of residents and patients. Medications are an increasingly important part of that care. The risks and benefits of medications are widely published, but not necessarily recognized in the care of individual patients. Decisions about medications must be made in the proper context of the patient. Medications are often indicated for various illnesses, symptoms, and risk factors, but clinically significant adverse consequences of medications are common and typically mimic common syndromes. Timely recognition and management of adverse consequences requires vigilance and a high index of suspicion. Many factors influence medication prescribing and use in the nursing home. Newly updated OBRA surveyor guidance emphasizes the importance of following the full care process in implementing, dosing, monitoring, and adjusting medications. Physicians and consultant pharmacists have prominent, complementary roles in addressing medications in the nursing home. The purpose of this article is to clarify these roles, identify their basis (primarily, the care process), and discuss how physicians and consultant pharmacists can collaborate effectively to optimize medication use and minimize preventable adverse consequences.