ISMP: Telepharmacy a safe answer to dangerous pending pharmacy deregulation in Texas, TSHP & ASHP call to action

An update on Texas HB1924, the dangerous pending legislation in Texas that will effectively allow a nurse to dispense drugs before a review by a pharmacist in small hospitals. Michael Cohen, the president of ISMP (Institute for Safe Medication Practices) wrote a letter to Texas state Senator Jane Nelson regarding Texas HB 1924 (see "Texas to scrap regulation?"), where he mentions telepharmacy as a valid alternative when on-site pharmacists are not available:

Hospitals that we visit that are under 100 beds have pharmacists onsite on a daily basis and often have pharmacist review of medications orders via telepharmacy during off hours. It is becoming more common to have pharmacists available on a daily or 5 days a week schedule in hospitals below 50 beds with on call coverage and remote medication order review via telepharmacy. Medications commonly used in today’s hospitals, regardless of size are highly effective but have great potential for toxicity if prescribed in error and available for use without pharmacist review. A revised standard would clearly be discriminatory as it would establish two levels of care for patients in hospitals in Texas and fail to assure patients in “rural” hospitals the basic safety standards considered essential in all other hospital patients.

There you have it, directly from the head of ISMP, "the nation’s only 501c (3) nonprofit organization devoted entirely to medication error prevention and safe medication use": Prospective drug regimen reviews by qualified pharmacists are what is safe, and using Telepharmacy to increase their availability is becoming more viable and is far better from a safety standpoint than the alternative.

UPDATE from TSHP (Texas Society of Health-System Pharmacists)'s newsletter on the matter today:

TSHP is calling upon its members to help defeat a bill that could spell the end of pharmacy practice in small and rural hospitals in Texas.

HB 1924, filed at the request of the Texas Organization of Rural and Community Hospitals (TORCH) was originally written in reaction to discussions of the Texas State Board of Pharmacy’s Task Force on Class C Regulations that indicated that some changes might be recommended in hospital pharmacy practice.

The bill would put into law TSBP regulations that are 30 years old, limiting the role of pharmacists to consultant drug use review 7 days after administration, and essentially allowing nurses to practice pharmacy in rural hospitals. It is estimated that this would have affected nearly 200 hospitals in the State.

TSHP has tried to meet with TORCH and the Texas Hospital Association to find a reasonable, middle ground for compromise. Our efforts have been rejected, and, in fact, TORCH has been successful in passing the bill out of the House of Representatives and it is now in the Senate Health and Human Services Committee, awaiting a hearing.

To make matters worse, TORCH has proposed a Senate Committee Substitute that would specifically prohibit TSBP from adopting ANY regulations that would require prospective drug use review by pharmacists in any hospital less than 100 beds, would allow a nurse and an unsupervised pharmacy technician to operate a hospital pharmacy WHENEVER A PHARMACIST IS NOT PRESENT and mandate that a pharmacist only retrospectively review drug dispensing every 7 days.

TORCH and some of its members believe that the cost of having a pharmacist prospectively review new, non-emergency medication orders outweighs the benefits to patient safety and health, even though they have been shown that such review can occur electronically and inexpensively.

Besides creating sub-standard care for patients in rural areas, the bill is a bad precedent for pharmacy and patient care in any hospital. Could this lead to our largest facilities operating with just a consultant coming by once a week, while nurses dispense and monitor patients’ drug therapy?

...

The matter is so critical that the Institute for Safe Medication Practices (ISMP) and ASHP have contacted the Senate to voice their concern over what will happen to patient care if this bill passes. For copies of their letters, see the TSHP website:

ASHP – http://www.tshp.org/ASHP1924.pdf

ISMP – http://www.tshp.org/ISMP1924.pdf

We don’t often have to ask for your help. We have a great legislative team. But against the combined lobby forces of rural hospitals and their county politicos, health-system pharmacy stands to be outgunned in this important battle.

Notice in ASHP's letter they also hint at the telepharmacy alternatives:

It is important, and in the best interest of patients, to ensure that the pharmacy practice act and its implementing regulations continue to evolve and reflect modern advances in medication therapy, technology, and the needs of the patient population.

More from the Telepharmacy Blog on Texas HB1924 as it develops.