New Study: 24/7 Order Review by Telepharmacists Reduces Medication Errors

There's a new study in AJHP where pharmacists from Tinity's Mercy Medical Center in Dubuque, Iowa reviewed 58% of the orders at 7 Critical Access Hospitals starting in the Summer of 2008:

Purpose. The implementation of a telepharmacy service to provide round-the-clock medication order review by pharmacists is described.
Summary. Seven critical access hospitals (CAHs) worked collaboratively as part of a network of hospitals implementing the same electronic health record (EHR), computerized prescriber-order-entry (CPOE) system, and pharmacy information system to serve as the health information technology (HIT) backbone supporting round-the-clock medication order review by pharmacists. Collaboration permitted standardization of workflow policies and procedures. Through the HIT backbone, both onsite and remote pharmacists were given access to the medication orders, the pharmacy information system, and other patient-specific clinical data in patients' EHRs. Orders are typically reviewed within 60 minutes of when they are entered into the system. The reviewing pharmacists have remote access to the EHRs in each CAH. After completing the clinical review, the pharmacist selects the appropriate medication to dispense from the CAH's formulary. If the medication order is not made using the CPOE system, the order is scanned into a document and sent via e-mail to remote pharmacists. The pharmacist enters the necessary information into the EHR and pharmacy information system. The medication order review process from this point forward is identical to that used for medications ordered via CPOE. The new medication order is then entered into the EHR, and the CAH nurse can proceed with the order.
Conclusion. The implementation of a telepharmacy model in a multihospital health system increased access to pharmacy services, allowing for round-the-clock medication order review by pharmacists.

You can read the full text here. A few interesting details: At a charge of $4 per order (wow, that seems expensive!), "the volume of and costs for medication orders reviewed remotely varies widely among the seven CAHs, from approximately 700 orders ($2,800) to over 2300 orders ($9,200) per month." Also, for the CAHs without CPOE, nurses scanned the order sheets which were then emailed to the remote pharmacists, but "Messages are sent without leaving the internal network to which the CAHs and MMC-Dubuque belong and therefore do not require Privilege Management Infrastructure encryption."

Two quick Telepharmacy updates

Photo by Tammy Lawson

First, Tammy Lawson of the Times Republican reports that the US government is building a new Veterans Affairs (VA) clinic in Marshalltown, Iowa whose pharmacy will be serviced by remote pharmacists. This no doubt sprung from their other work in Iowa where they identified the program as one of their best and most efficient.

Second, an update on Comprehensive Pharmacy Services' newly acquired remote pharmacy division, now with a new name, comes from a small article buried in Memphis' Commercial Appeal online magazine:

Rx Remote Solutions

Comprehensive Pharmacy Services has renamed its newly acquired remote-order-entry division to Rx Remote Solutions.

Memphis-based CPS bought Napierville, Ill.-based RxKnights Inc. in June for an undisclosed amount.

Rx Remote Solutions employs pharmacists at a call center who answer calls from health care facilities including hospitals, nursing homes and behavioral health centers.

The pharmacists will have access to the facilities' patient files and will be able to review and approve medication orders even late at night.

It will be interesting to see how they do entering the remote pharmacy market around the US. You can bet the Telepharmacy Blog will be covering it.

VA implements telepharmacy, "Safety, efficiency, and patient satisfaction improved"

In their OIG report, they claim "Safety, efficiency, and patient satisfaction improved with the implementation of the telepharmacy program".

In his post New Reports From the VAOIG, Mike Fielder says "We identified the telepharmacy program and QM program redesign as organizational strengths."