Positioning Remotely Delivered Pharmacist Care in Small and Rural Settings
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1 Positioning Remotely Delivered Pharmacist Care in Small and Rural Settings Kelly Morrison Director of Remote Pharmacy Services Cardinal Health Richard Stomackin, BS. Pharm Director of Pharmacy Geisinger Lewistown Hospital
2 Objectives Understand remote pharmacy services models and deliverables Understand how to determine when remote pharmacy services could be an alternative in your facility Develop guideline criteria to evaluate remote pharmacy service alternative delivery models Identify problematic areas and develop action plans for success Please note that the views expressed by the conference speakers do not necessarily reflect the views of the American Hospital Association and Health Forum.
3 Pharmacy Challenges Providing a consistent level of care >70% of hospital pharmacies do not provide 24x7 coverage CMS, accreditation organizations and pharmacy boards have regulations regarding review of orders by pharmacist prior to dispensing 24x7 Increased adoption in meaningful use technology Increase demand on pharmacist labor and 24x7 pharmacy support
4 Meaningful Use Technology Adoption Adoption Rate Trend 100% 80% % Adoption Rate 60% 40% 20% 0% CPOE 15% 26% 31% 35% 47% 86% BCMA 21% 29% 33% 41% 46% 90% *data courtesy of Pharmacy Purchasing& Products magazine, August 2011, 2013
5 CPOE Order Volume Trends On average, order volume increases by 30+% post CPOE adoption
6 Remote Order Processing Models SERVICE PROVIDERS Contracted services In-house services COVERAGE After-hours Supplemental Order Entry Order Review Clinical Intervention Drug Information Video Verification Remote Supervision
7 Rural Hospital Challenge Non-24 hour pharmacy National pharmacist shortage Pending emar and CPOE implementation Requires 24x7 pharmacy Decision: Leverage existing staff? Hire additional staff? Evaluate remote pharmacy services?
8 Approach Investigated Pennsylvania remote pharmacy regulations Require pharmacists to be licensed in PA Requires PA pharmacy site license Researched remote pharmacy contract providers
9 Guideline criteria to select provider Remote experience, licensure Service hour availability 8pm-6am Weekdays; 4pm-6am Weekends/Holidays Technology capabilities & redundancy Training process Communication protocols shift hand off & on-going Problematic order process (clinical interventions) Adhere to hospital specific policies and procedures Quality assurance process Daily/monthly reporting capabilities Productivity, Clinical & Quality
10 Transition to remote pharmacy services Standardize and document operational policy and procedures; maintain as needed Collaboration and approval from IT team In-service nursing on remote process Daily communication with remote service during initial transition
11 Results Successfully implemented emar and CPOE Pharmacy provides a consistent level of care 24x7 Reduced PADE s after-hours and on weekends Reduced nursing overrides in automated dispensing machines Improved pharmacy and nursing satisfaction
12 Order Processing Time Report Geisinger Lewistown Hospital, 2013 Results Average order processing time 13 minutes
13 Clinical consultations 60% consults are clinical dosing service and CPOE order modifications
14 Estimated annualized labor savings
15 Regulatory & State Law Considerations Accreditation requirements Terminology varies by state Licensure / operations requirements Facility Personnel Intrastate restriction Other Is language in regulation or enforcement policy? Evolving regulation Board of Pharmacy concerns
16 Resource ASHP Guidelines on Remote Order Processing ary/bestpractices/autoitgdl RMOP.aspx
17 Discussion
18 Thank you! Kelly Morrison Director Remote Pharmacy Services Cardinal Health Richard Stomackin, BS. Pharm Director of Pharmacy Geisinger Lewistown Hospital
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