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Telepharmacy supports eMAR and more, 24-7

By Rebecca Agar, BSc.Phm, RPh

In January 2014, North West Telepharmacy Solutions (NWTS) undertook an ambitious project to assist in getting a rural hospital pharmacy department ready to implement 24-7 pharmacy services in only 100 days.

The Huron Perth Healthcare Alliance (HPHA) is comprised of four hospitals: Clinton Public Hospital, Seaforth Community Hospital, St. Marys Memorial Hospital, and Stratford General Hospital. These rural hospitals are spread out over approximately 2500 km2 and have 189 patient-care beds in total.

HPHA’s pharmacy has a partnership with Alexandra Marine & General Hospital (AMGH) in Goderich, which has 42 beds. The HPHA main pharmacy is located at the Stratford site with daily deliveries to the three other hospital sites. NWTS has provided pharmacist order review and clinical pharmacist services to HPHA since 2010.

In March 2013, the South West Local Health Integration Network (LHIN) provided HPHA & AMGH with a Small and Rural Hospital Transformation Fund grant to support the EMPOWER project. The EMPOWER project was designed to improve the safety of the medication system with the introduction of Electronic Medication Reconciliation (eMedRec), Electronic Medication Administration Record (eMAR) and Bedside Medication Verification (BMV).

The HPHA & AMGH pharmacy departments were already using Omnicell automated dispensing cabinets, the Meditech MAGIC v.5.64 Health Care Information System and the Iatrics Visual SmartBoard for drug order entry, drug order review and patient medication therapy clinical monitoring.

The pharmacy departments also had existing processes to pre-pack medications into unit-dose formats when not available from manufacturers. Additionally, HPHA & AMGH had a well-established working relationship with North West Telepharmacy Solutions (NWTS), providing remote pharmacist services for drug order review and clinical pharmacy services, in addition to the on-site pharmacists.

Turning to North West to assist in staffing, project planning, training and staff backfilling was a natural choice for HPHA and AMGH, says Pamela Davidson, HPHA Supervisor of Pharmacy Services, “North West has always been there for us whenever we have needed help, ready at a moment’s notice. We never would have been able to accommodate the increase in pharmacist hours with our own staff, and the fact that North West covers all of the overnight shifts have kept our staff very satisfied. It was also great to be able to draw on the experience of a company that has implemented overnight pharmacy service at other hospitals.”

Ryan Itterman, Director of Pharmacy Services for both HPHA and AMGH, highlighted the unique ability of North West Telepharmacy to customize its services to accommodate innovative pharmacy service models: “North West has supported the partnership between AMGH and HPHA through the provision of pharmacist resources on an ‘as-needed’ basis with the innovative use of technology to efficiently support our multiple hospital sites.”

The HPHA pharmacy department’s operating hours and staffing levels were adjusted to allow for 24-7 coverage, to support timely pharmacist medication order entry and review for eMAR.

As HPHA already had a well-established relationship with NWTS, providing remote hospital pharmacist coverage, these off-peak extended after-hours are staffed by a remote NWTS pharmacist. From 1900h to 0700h, this remote pharmacist performs all medication order entry and order review, and provides clinical support and drug information services. A pharmacy technician is on call during this time to supply any medications not stocked in the Omnicell cabinets, as required.

An extensive on-line training program was developed by the NWTS Site Lead to ensure that the 20 pharmacists were trained and ready to perform independent order entry before the mid-March go-live date. This allowed the NWTS staff to undergo training on their own schedule and review information as desired. NWTS also ensured that their staff received one-on-one mentoring for medication order entry.

Due to pharmacist staffing issues, hospitals in Canada have lagged behind in ensuring medication orders are reviewed before administration. The telepharmacy model of care has been shown to be an efficient, cost-effective and viable solution to support 24/7 pharmacist medication order review and facilitates the implementation of eMAR and BMV.

Approximately 70 percent of US hospitals have 24/7 pharmacist medication order review, and 28.8 percent of those hospitals utilize telepharmacy services to achieve their goal.

Patient Safety is enhanced significantly by the implementation of these programs. Numerous studies by the Institute for Safe Medication Practices (ISMP) have shown that timely medication order review and the use of barcoding technology for BMV plays a powerful role in reducing medication errors.

NWTS provides remote pharmacy services for over 40 different facilities across Canada, but had never collaborated on a project of this magnitude prior to this point.

NWTS pharmacists backfilled for HPHA and AMGH pharmacists who were working on the EMPOWER projects, staff training, as well as assisting in policy development.

At present, on-site HPHA and AMGH pharmacist complete minimal medication order entry tasks, allowing them to focus on clinical activities and patient care. All overnight pharmacy shifts and a majority of the daytime shifts on weekends and holidays are serviced by NWTS pharmacists. The telepharmacy services have also maintained HPHA & AMGH pharmacy staff satisfaction and ensured staff retention.

Kevin McDonald, senior manager at NWTS, says the growth of telepharmacy services over the next several years will be driven by hospital organizations requiring pharmacy services to be available around the clock, which includes 24/7 pharmacist medication order review. This will help ensure that no medication is administered by a nurse without a pharmacist having reviewed the clinical appropriateness of the medication – a natural patient safety safeguard already in place during daytime hours.

This is a logical time for hospitals to look at expanding their hours of operation and increasing their use of existing technologies to embrace eMAR & BMV with their own resources or considering the use of North West Telepharmacy Solutions.

“The nice thing about utilizing NWTS for overnight coverage and large-scale project implementation is that hospitals only need to pay for the coverage necessary for that site,” said McDonald. “We can offer a realistic and affordable solution to any hospital of any size.”

Rebecca Agar is a licensed pharmacist with North West Telepharmacy Solutions. Please see: http://www.northwesttelepharmacy.ca

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