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At Small, Rural Hospitals, Telepharmacy Technology is Advancing Pharmacy Practice

November 3, 2016
by Heather Landi
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Just as with many other areas of hospital operations, healthcare leaders are increasingly adopting and implementing IT solutions within pharmacy departments to streamline medication-management systems, improve workflow and increase patient safety.

Yet even as many healthcare IT leaders see the benefits of adopting IT solutions such as computerized provider order entry (CPOE) systems, there are numerous barriers and challenges connected to CPOE technology when it comes to pharmacy operations. Indeed, without including the key hospital stakeholders, especially clinical pharmacy and nursing staff, hospitals can find it difficult to realize all the advantages of CPOE systems.

Many hospital pharmacy leaders at small, rural hospitals, in particular, are finding that, as with many other IT implementations, the initial deployment of these technologies can actually create unintended challenges for physicians, clinicians and pharmacists. For smaller hospitals faced with budget constraints and limited resources, transitioning from the traditional paper-based prescription pad to digital processes for prescribing and medication review requires careful consideration of the financial and staffing complexities.

To this end, many hospitals are deploying telepharmacy services to support their CPOE technology and are finding that the combination of telepharmacy and CPOE tools has enhanced provider workflows, medication safety, patient safety and even the financial bottom line.

Kelly Meeks, the director of pharmacy (DOP) at Crawford Memorial Hospital, a critical-access hospital in Robinson, Illinois, says the 25-bed hospital implemented a CPOE system in 2008, yet there were challenges to clinician adoption and use of the technology. “The challenges were prescriber-specific, so doctors who are very tech-savvy took to it. It’s a big change and requires certain thinking and thought processes. Electronic orders don’t always mirror the clinicians’ thought process. So, some doctors easily made that transition and some had trouble. It was not a mandatory thing, until the Meaningful Use criteria hit,” Meeks says.

Many smaller hospitals do not provide 24/7 on-site pharmacy coverage as hospital executives are challenged with rationalizing expanding pharmacy departments and hiring expensive resources when the volume isn’t there. “As a critical-access hospital, we’re a small, rural hospital, we don’t have 24/7 pharmacy services, so from 8 am to 4:30 pm the orders come to pharmacists for verification,” Meeks explains. “After 4:30 pm, the medication orders go to nurses for acknowledgment, but prior to deploying telepharmacy services, those orders waited until 8 am the next morning, at which point the pharmacists, who are trained for looking at drug therapy management and renal dosing, reviewed them. So there was a gap in the pharmacists’ review of the medication orders.”

In 2011, Crawford Memorial deployed a telepharmacy platform working with PipelineRx, a San Francisco-based company that provides medication management services with a focus on clinical telepharmacy. Two years later, in 2013, Crawford Memorial expanded its CPOE systems to the emergency room and physicians, clinicians and pharmacists found that implementing telepharmacy not only filled critical gaps in pharmacy services but also improved the efficiency of the CPOE process.

Kelly Meeks

“Not having a pharmacist here two-thirds of the day, that’s a huge gap in pharmacy services and the telepharmacy service provides 24-hour medication order review and verification by a clinical pharmacist. We were looking to use this telepharmacy platform to close that loop and optimize our operations,” Meeks says. Prior to the use of telepharmacy services, Meeks and her pharmacy staff were spending 30 minutes to three hours in the morning catching up from the orders that came in overnight. “It’s difficult to efficiently care for patients in the morning when you’re spending so much time catching up. This process enhances efficiency and safety,” she says.

At Claxton-Hepburn Medical Center, a 102-bed hospital in Ogdensburg, N.Y., hospital leadership implemented telepharmacy technology while also rolling out an electronic medical record (EMR) system and those implementations occurred six months prior to deploying the CPOE system.

“One reason we brought in telepharmacy services is that, as a rural hospital, we’re not 24/7,” Greg Guimond, director of pharmacy at Claxton-Hepburn Medical Center, says. “Knowing that we were going to an EMR, the chief nurse operator wanted all the information available electronically so orders show up in the EMR to be verified by a pharmacist. So that meant either bringing on a second or third shift as we’re 7 [am] to 5 [pm] seven days a week, or going with a telepharmacy service,” he says.

Claxton-Hepburn Medical Center also uses a telepharmacy platform provided by PipelineRx. The company provide hospitals with a fully managed and staffed remote medication order verification (RMOV) service. The hospitals have access to trained clinical pharmacists, and also specialty pharmacists such as oncology, for continuous medication order review baesd upon each hospitals’ established systems, policies, procedures, protocols and formulary.

Clinician and Pharmacist Workflow

Some hospital leaders have found that the use of CPOE systems can double the workload for the hospital pharmacist and can actually slow down turnaround times.

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