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Telepharmacy helps to improve pharmacy services
Rural pharmacy able provide broader services
A 25-bed critical access hospital that wanted to improve pharmacy services through use of automated dispensing machines and remote pharmacist review of orders found telepharmacy could help it achieve its objectives, a researcher found.1
Telemedicine is defined by the Institute of Medicine as "the use of electronic information and communications technologies to provide and support healthcare when distance separates the participants." Telepharmacy is a subset of telemedicine that focuses on the pharmacy-related aspects of telemedicine, including dispensing of medications and information and the provision of pharmaceutical care to patients from a distance.
Lead author Adam Boon, PharmD., who is now pharmacy operations manager at Iowa Lutheran Hospital in DesMoines, describes the telepharmacy experiment he participated in when he worked at a small critical access hospital in southern Indiana that partnered with Louisville's Jewish Hospital.
The pharmacy staff at the small hospital consisted of Mr. Boon and a half-time pharmacy technician. The daily census averaged 10 patients. The hospital's pharmacy services were run through the 442-bed regional hospital in Louisville. Jewish Hospital provided pharmacy staff, relief staff, and technical assistance when needed at the rural facility.
Boon says there were great challenges in providing effective pharmaceutical cognitive services at the rural setting, including the main obstacles of a lack of staffing and of funding for new initiatives. To a lesser degree, he says, other health professionals' perceptions of what type of pharmacy services should be provided to the hospital were also a concern.
Trying to improve pharmacy coverage for the rural hospital, after-hour services were made available through the regional hospital, which had 24-hour pharmacy service. While setting up the remote pharmacy coverage, several conditions were established. It was decided that because the regional facility did not provide remote pharmacy services on a regular basis and would not charge the smaller facility for services rendered, after-hours orders would only be processed in emergency situations. The nursing staff would then be able to access the majority of medications on the formulary from an automated dispensing machine. Any questions requiring a pharmacist's input would be referred to the regional hospital whenever the smaller hospital's pharmacy was closed.
A pharmacist using a remote computer at the pharmacist's home provided weekend coverage. Orders were faxed to the pharmacist's home and processed throughout the day. Weekend coverage was rotated among three pharmacists.
While there were challenges in setting up the program, Mr. Boon says, there also were factors that allowed for an easy transition permitting implementation of the expanded services. First, pharmacists at Jewish Hospital were licensed in both Kentucky and Indiana. Second, the two hospitals' computer systems were the same and thus pharmacists from each facility knew how to use the system with little or no additional training. The system also allowed the pharmacists to access it from any Internet connection. For weekend coverage, laptop computers were provided to each pharmacist.
Third, the two hospitals used similar formularies. The rural hospital's pharmacy and therapeutics committee adopted a majority of the formulary substitutions allowed at the larger hospital. A copy of all formulary substitutions was made available to all staff involved in assessing and entering pharmacy orders. The pharmacy computer system was later upgraded to perform an autosubstitution function to identify non-formulary medications and provide the pharmacist reviewing the order with alternate formulary options. That function also enabled the smaller facility to expand its formulary to fit its own needs without having to conform to the larger facility's formulary.
Next, a selection of medications was available through automated dispensing machines. The machines provided quick access to nurses and a faster turnaround time for order processing. All medications available at the rural hospital were stocked in at least one automated dispensing unit within the hospital. Only high-risk medications continued to be stocked only in the pharmacy, and the nursing staff could access the pharmacy only in emergency situations.
Boon tells Drug Formulary Review he believes his experience at the rural critical access hospital is replicable in general. "You see it a lot more these days," he says, "including companies that do remote order entry as a service for small hospitals." He says the key to success is a larger hospital with a good information technology department that has the same computer system as the smaller hospital.
[Editor's note: For more information contact Boon at firstname.lastname@example.org.]