Is your pharmacy providing 24/7 coverage?

Nov 20, 2006

By: Anthony Vecchione

Health-System Edition

At most large tertiary care hospitals and academic medical centers, around-the-clock pharmacy service is relatively common. But in some small and rural hospitals, 24-hour, seven-day-a-week pharmacy coverage is not economically feasible or practical. How are pharmacy services provided in those facilities? And how do health-system pharmacists feel about a Joint Commission on Accreditation of Healthcare Organizations proposal that would require all hospital pharmacies to provide 24/7 service?

Drug Topics commissioned a survey to understand how hospitals provide comprehensive pharmacy services off-hours and on weekends.

Here's a summary of the findings.

In response to the question, Does your hospital provide 24/7 pharmacy service? 64.3% of respondents answered in the affirmative.

Of those respondents who said their hospital has 24/7 pharmacy service, an overwhelming 87.9% indicated that their hospital had its own pharmacists on site 24 hours per day, while 6.4% reported that they used a pharmacist in a remote location to review drug orders during off hours. Only 5.7% of the respondents said that pharmacy services are provided by "other" means, but they did not elaborate.

According to pharmacists who do not have 24-hour pharmacy service, 93.8% stated that they use automated dispensing cabinets in the off hours, while 6.3% said that their hospital uses a locked cabinet with medications.

Of those respondents who do not have 24/7 pharmacy service, 88.4% said that their hospital has no plans to implement a 24/7 service next year, but 11.6% said that they intend to initiate such a plan.

When asked to rate their satisfaction with their pharmacy department's current 24/7 service, 27.7% of the respondents who have such pharmacy coverage said that they were extremely satisfied, 39.8% were very satisfied, and 29.5% were satisfied. Only 2.7% said that they are not satisfied with their current service and a mere .3% said that were not at all satisfied.

Some respondents explained why they are dissatisfied with their department's current 24/7 status. Here's what one had to say: "Only one pharmacist is on duty, what happens if he or she gets really busy or stuck in the ER? There's no one to call to cover." Another R.Ph. said, "We don't adequately staff the graveyard shifts. We don't have a plan in place for when demands exceed resources."

Thirty-two percent of the respondents said that their pharmacy operated on day and evening shifts but was closed overnight, while 10.5% reported that the pharmacy operated only from Monday through Friday but was closed on weekends.

Of the respondents who said that their hospital does not offer 24/7 pharmacy coverage, 35.6% reported that hospital staff members are allowed to access medications when the pharmacy is closed. However, 64.4% said that the practice was prohibited.

Of those hospital staff members who are allowed to access medications after-hours, 73% are nurses, 4.9% physicians, 1.6% paramedics, and 19.7% fell into the "other" category. Forty-two percent of respondents who reported that hospital staff members are allowed to access medications after-hours said that they can do so by using an automated dispensing machine outside of the pharmacy. Only 4.8% said that no arrangement has been set up for nonpharmacist personnel to access meds when the pharmacy is closed.

JCAHO oversight

When asked the question, Should JCAHO require all hospital pharmacies to provide 24/7 service? only 39% of respondents believe that JCAHO should require all hospital pharmacies to provide such service. Sixty-one percent disagreed with that premise.

The top two reasons why respondents believe that JCAHO should require hospital pharmacies to provide 24/7 coverage are the following: it will improve patient safety (33%) and patients will receive better care if a pharmacist reviews their drug regimen (26.7%).

Twenty-five percent of the respondents said that JCAHO-mandated 24/7 pharmacy coverage would improve the quality of the clinical care and operational aspects of the pharmacy service, while 12.2% said pharmacists would help reduce drug costs. About 2.5% of the respondents cited "other" reasons why JCAHO should require all hospital pharmacies to provide 24/7 coverage.

One respondent said that requiring all hospital pharmacies to provide 24/7 service would "make for better rapport between physicians, nurses, and pharmacists." Another pharmacist commented: "Pharmacists are the clinical medical experts and should be utilized 24/7. That's the business we are in."

How does your pharmacy allow other hospital staff to access medications after-hours?

Of the respondents who do not believe JCAHO should require all hospitals to provide 24/7 service, 44% said they feel this way because many small and rural hospitals cannot afford to provide that level of service. Thirty-one percent cited the pharmacist shortage and the difficulty in securing adequate pharmacy staffing. "I do not believe that there is enough work to demand that the pharmacy remain open 24/7," said one respondent. "If it's a small operation, very few orders are written during the night; a pharmacist should be on call," stated another respondent.

State regulations

Respondents were asked whether their state currently had established rules related to telepharmacy. Only 17.7% of respondents reported that their state had such rules, 20.8% said that their state did not, while 61.5% didn't know.

Almost 74% of participants who reported that their state had rules related to telepharmacy believe that those rules are a benefit because they establish parameters for telepharmacy to occur. In contrast, 10% said that those rules create a risk of displacing on-site pharmacists, while 4.3% said that the rules are too restrictive. Just over 11% expressed "other" opinions.

Respondents' satisfaction with their pharmacy department's current 24/7 service

Of the 20.8% of pharmacists who stated that no rules are established in their state regarding telepharmacy, 67.1% feel that their state board of pharmacy should enact rules that would allow for telepharmacy to take place.

In our survey, 40.6% of respondents think that telepharmacy services across state lines are an acceptable solution for extending night coverage. Here's what a few of these respondents had to say:

• "As long as the orders are being reviewed by a licensed pharmacist, I don't think it matters what state they are being reviewed in."
• "As long as the out-of-state pharmacist is aware of the different laws and able to make clinical decisions in providing patient care," telepharmacy across state lines is acceptable.
• "Health care is health care. What does an imaginary line on a map have to do with it?"

Those opposed to telepharmacy made these comments:

• "A physical presence of a pharmacist within the facility is needed to provide continuity of care to all patients no matter what the time of day or night. Different state laws may be a factor that can hinder care, as could a lack of knowledge of the particular patients and his or her treatment."
• "An on-site pharmacist is needed to dispense medication and respond to codes."

"An off-site pharmacist, especially in another state, cannot possibly handle pharmacy issues in another hospital, except to answer general questions."

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