Improving Patient Safety by Utilizing Remote Pharmacist Services

1
Improving Patient Safety by Utilizing Remote
Pharmacist Services

• More Pharmacist Involvement with ISMP Patient
  Safety Standards
• Meet the Future Expectations for Medication
  Management from JCAHO

2

• The proposed revision to MM standards includes
  the following

• "when an on-site licensed pharmacy is not open 24
  hours a day, seven days a week, the organization
  must make arrangements for a pharmacist's review
  of medication orders during these hours."

3

• Announced in December 2004 as a Proposed Rule
  Change in 2006.
• Analyzing feedback at this time.
• No official position.
• Verbally - probably will not be in effect until
  at least Mid 2009 or later.

4
A policy statement approved by the ASHP House of
Delegates in 2003

• To support the use of remote medication order
  review systems that communicate pharmacist
  approval of orders electronically to the
  hospital's automated medication distribution
  system further,
• To advocate alternative methods of pharmacist
  review of medication orders (such as remote
  review) before drug administration when onsite
  pharmacist review is not available further,
• To promote the importance of pharmacist access to
  pertinent patient information, regardless of
  proximity to patient.
• To support the principle that all patients should
  have 24-hour access to a pharmacist responsible
  for their care.

5
Current Regulatory Status of Remote Pharmacy
Services

• Remote order review by pharmacists is legally
  allowable in 42 states and is being considered
  in those remaining.

• The Illinois Pharmacy Practice Act enacted
  January 1, 2008 contains specific language
  allowing for remote processing of medication
  orders.

• I am a member of the state-wide committee
  currently writing new rules and regulations for
  pharmacy compliance with this new act.

6
Existing Remote Pharmacy Options

• Remote order review and entry is legally
  allowable in 42 states and is being considered in
  those remaining.
• National vendors such as Cardinal Rx e-source.
  There are 6 call centers in different parts of
  the country currently servicing 10 or more
  hospitals per center.

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Other Options

• Small hospital contracts with larger hospital
  with existing 24/7 pharmacy staffing in region or
  state to provide pharmacist remote order review.

• complex connectivity and information exchange
  challenges

• Unaffiliated small hospitals in a region
  collaborate to create and share 24/7 pharmacy
  services.

• more complex connectivity and information
  exchange challenges

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Why the ICAHN model fits better than the large
corporate providers

• ICAHN pharmacists are responsible for fewer
  remote sites allowing host hospitals to retain
  more of their special case processes in place
  to maintain nursing and physician satisfaction.

• ICAHN pharmacists interact face-to-face more
  frequently with the host hospital nursing,
  medical, and pharmacy staffs.

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Host Hospital ? ICAHN Model

• Benefits include

• Cost-effective compliance with JCAHO MM
  standards.

• Enhanced recruitment and retention of host
  hospital pharmacy staff by eliminating backload
  of orders and on-call obligations.

• Cost-effective supplemental coverage for pharmacy
  department short-staff situations (high census,
  staff emergencies, meetings, seminars, etc).

• Timely review of med orders by ICAHN pharmacists
  to
• provide pharmaceutical care to all patients
  regardless of when the med order is written.
• monitor and maintain compliance with protocols
  and pathways to support hospital quality
  assurance initiatives.

10
Nursing ? ICAHN Model

• Benefits include

• Timely medication order review by ICAHN
  pharmacists to support optimal medication
  administration by
• selection of appropriate dosage forms
• selection of appropriate dosing times
• determination of IV compatibility and stability
• correction or clarification of other medication
  related issues

• Interaction directly between ICAHN pharmacist and
  prescriber, keeping nursing staff out of the
  middle of medication order reconciliation and
  reduce the delay of onset of medication
  therapies.

• Uniform and consistent nursing processes for
  handling physicians med orders regardless of
  hospital pharmacy hours.

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Inpatient Pharmacy ? ICAHN Model

• Benefits include

• Virtual handoff of physician order reconciliation
  between host hospital pharmacists and ICAHN
  pharmacists to

• eliminate backlog of med orders waiting for day
  shift pharmacist to catch up in the morning.

• reduce on-call obligations of hospital pharmacist
  by timely assistance to nursing staff with
  medication related activities.

• provide supplemental virtual coverage for
  hospital pharmacist for meetings, emergencies,
  etc.

• continue pharmacist monitoring of protocols and
• pathways.

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Clay County Hospital Medication Order Volume and
Distribution

• Clay County Hospital Stats 2006-2007
• Avg Daily Census 13.4
• Avg Pages of Physicians Orders/day 52
• Avg Medication Orders/day 136
• Daily distribution of pages / med orders
• 0730-1600 Mon-Fri 32 pages / 67 med orders
• 0730-1600 Sat-Sun 19 pages / 44 med orders
• 1600-2300 Sun-Sat 18 pages / 54 med orders
• 2300-0730 Sun-Sat 10 pages / 22 med orders

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Pharmacist Response Time During Normal Operating
Hours
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Where Do We Go from Here?

• Conduct a 3 month pilot project by expanding from
  the two current critical access hospitals (both
  using the same clinical software) to four
  hospitals.
• Introduce the variables of different clinical
  software, MAR configurations, medication access,
  etc.
  two original facilities currently share
  same computer system (HMS).
• Develop a business plan from the results of the
  pilot and begin providing remote pharmacist
  services to small and rural hospitals utilizing
  the ICAHN model.

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ICAHN REMOTE PHARMACY PROJECT

• Tellurian Networks Inc.
• Hanns On Software
• Hamilton Memorial Hospital
• Tara Gorden, RPh
• Clay County Hospital
• Larry Sanders, RPh
• Ferrell Hospital
• Tom Stanford, RPh
• Washington County Hospital
• Jim Lynch, RPh

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TELLURIAN NETWORKS INC.Newton, New Jersey

• Tellurian Networks is a nationwide provider of
  electronic practice management and medical
  records hosting solutions. Tellurian was founded
  in 1995 and has over 10,000 clients around the
  world .
• Tellurian is also the data center and managed
  service sponsor of National ePrescribing Patient
  Safety Initiative (NEPSI), a coalition of leading
  healthcare and technology companies that is
  dedicated to eliminating preventable medication
  errors by providing electronic prescribing at no
  cost to every physician in America.

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TELLURIAN NETWORKS INC.Newton, New Jersey

• Daily tape backups
• Testing of data restore
• Spare hot-site
• Liaison for support with the Hanns On Software
  (HOS)
• Hardware maintenance, repair and replacement as
  well as upgrade of equipment every 36 months
• 90 day testing window
• VPN and Terminal Server

• 24/7 phone support
• Patch management, security updates and HOS
  software version upgrades
• Work with HOS to set up benchmarking software to
  determine and monitor performance levels
• Service Level Agreement with System Performance
  Availability Guarantee

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HANNS ON SOFTWARESanta Rosa, California

• Hanns On Software (HOS)provides
  industry-leading software and services to
  healthcare facilities across the U.S. The company
  was founded in 1987 and is still owner operated .
  The staff includes experienced pharmacists,
  nurses and IT professionals.
• Ascend is able to operate a mixture of
  facility/service types (e.g. inpatient,
  outpatient, infusion services, and etc.) all from
  one shared server/database.
• HOS provides web-based and phone support, imbeds
  remote-desktop support access within the Ascend
  software, and provides a customer list serve to
  foster communication among customers and support
  staff. They provide 24/7 support as part of the
  standard license.

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HANNS ON SOFTWARESanta Rosa, California

• Ascend can support multiple facilities with a
  single Microsoft SQL Server database making it
  easy and economical for an organization to
  operate multiple facilities from a single central
  location.
• Each facilitys data is logically separated from
  users at other facilities as required by HIPAA
  and hospital security policies.
• Ascend can be shared remotely by using a
  centralized Citrix or Terminal Services server.

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TIMELINE

• DAYS 1-30
• Tellurian configuration and testing of
  connectivity, security and printing capabilities
• Installation and configuration of HOS Ascend to
  allow and populate four separate and distinct
  databases
• DAYS 31-75
• Pharmacists testing of Ascend
• DAYS 75-90
• Evaluation of project and generation of a
  business plan

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Questions?
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Think of More Questions? Contact Us

• Larry Sanders, RPh, MS
• Clay County Hospital
• cchrph_at_wabash.net
• 618-662-1653
• Kim Larkin, CIO, MBA
• Washington County Hospital
• klarkin_at_washingtoncountyhospital.org
• 618-327-2203