Transcript telepharmacy an institutional perspective

North Dakota Telepharmacy Project
Hospital Telepharmacy Model
Slide presentation by John S. Skwiera, R.Ph.,
Heart of America Medical Center, Rugby
What Is Hospital
Telepharmacy?
 Is it a means to provide access to medications
via automation?
 Is it a means to provide ready access to
medications and professional services?
IT CAN BE BOTH!
Automation
 Pyxis, Omnicell -- automated dispensing
equipment
 Expensive
 Data entry with verification necessary
 Is not the answer to everything
ND Telepharmacy Model
Utilizes the unique skills and knowledge
of technicians, nurses, pharmacists,
physicians, and related health
professionals to optimize the care of the
patient while overcoming current and
future barriers to patient care
ND Telepharmacy Model
 Recognizes that technology is limited
 Recognizes that the practice of pharmacy
is still an art
 Utilizes people and technology, each one
complementing the other in the service of
the patient
Why Do It?
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Maintaining quality of care
Easing pharmacist shortages
Improving of the pharmacist’s life
Maintaining the bottom line
Complying with regulations
Pharmacist Demographics
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There are not enough pharmacists
We can’t “burn out” the pharmacists we have
Pharmacists in many rural hospitals are aging
Recruitment of young pharmacists to rural
areas is lagging
Maintaining
Quality of Care
 Using the best personnel possible for
medication order entry, evaluation, and
dispensing of medications
 THE PHARMACY TECHNICIAN
 THE PHARMACIST
 Their unique skills and talents complement
those of nursing and other health care
professionals
Easing Pharmacist
Shortages
 Telepharmacy may be the only feasible
option for:
 Emergency coverage
 After hours coverage
 Weekend coverage
 Vacation coverage
 Routine pharmacy operations
Improving the Lives of
Hospital Pharmacists
 Reducing stress
 Assisting in staff retention and
recruitment
 Keeping open
Maintaining the
Bottom Line
 Staffing a pharmacy with a technician is
cost-effective
 Pharmacist coverage via telepharmacy
may cost less than an on-site pharmacist
Complying With
Regulations
 Stringent CMS and JCAHO guidelines for
pharmacist review of orders prior to the
administration of any medications, except in
emergencies
 Possible restriction of access to the pharmacy
of non-pharmacy personnel
 State and federal regulations
Telepharmacy in the Hospital
Setting
First Steps
 Commit to following through!
 Seek out partners
 Seek assistance from NDSU College of
Pharmacy and the ND Board of
Pharmacy
 Educate administrators, corporate
executives, and staff
Next Steps
 Apply for funding (ND Telepharmacy Project)
 Determine components (both hospital and
home units) and equipment needs
 Develop policies and procedures and business
associate agreements/contracts
 Choose an internet provider
 Obtain bids for equipment, installation, and
servicing
Telepharmacy
Components
 Institutional component
 Hospital to hospital
 Community pharmacy to hospital
 Provides services between two sites for
scheduled telepharmacy operations
Telepharmacy
Components
Pharmacist’s home to institution for
unscheduled absences of a pharmacist
due to illness, inclement weather, etc.
Equipment Needs
 Polycom unit with a document camera
(optional at home sites)
 Personal computer and/or institutional network
access
 Equipment and software
 Security (VPN, firewalls, anti-virus software)
and access
 Satellite dish (optional at home sites)
Approximate Costs
 Polycom VSX, PCs, monitors, high resolution
document camera(s), misc.: $12,000+
 DSL: up to $150/mo.
 Virtual Private Network (VPN): $1,000
 Equipment Installation: $1,500+
 Software as needed
 Remodeling as needed
 Counter space: ca. 5 linear feet
Paperwork/Documentation
 Telepharmacy Policy/Procedure -- establishes
standards of pharmacy practice
 Business Associate Agreement -- establishes
contractual agreements and outlines
adherence to HIPAA regulations
 Grant requirements -- expense tracking and
reimbursement
 Error/near-miss tracking
Telepharmacy Policy
 Must insure maintenance of quality care
 Must insure adequate evaluation and
verification of technician work
 Must incorporate policies for resolving
any questions, discrepancies, or errors
 Must be in accordance with law to the
satisfaction of the Board of Pharmacy
Telepharmacy Policy
 Can delineate the qualifications and
training of staff
 Can have anything that the partners want
in it (within reason)
 Can not contradict current policies within
each participating hospital
Recommended Reading
“Rural Hospitals and Telepharmacy” by
Petra S. Berger (Risk Management and
Patient Safety Institute)
www.rmpsi.com
The Procedure
 Order entry by the technician
 Verification of order entry by the
supervising pharmacist -- this is
accomplished by placing a hard copy of
the physician’s order under the document
camera and comparing it to the
technician’s computer entry
The Procedure
 Verification of the drug and label by the
supervising pharmacist -- this is done by
placing the drug and label under the
document camera
 Release of the drug
 Documentation of the transaction by the
technician or pharmacist
Who Sees What?
 Each pharmacist can have access to another
site’s pharmacy information system, as allowed
by the software -- ideally, it would be
compatible
 The pharmacist can view and approve a
technician’s work at the other sites, as allowed
Evaluate
Verify
Identify Meds
Pitfalls
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Institutional resistance
Corporate resistance
Staff resistance
Lack of time to implement
Lack of ongoing financial commitment
Challenges in terms of systems compatibility
and connectivity
Future Possibilities
 The addition of sites to existing hospital
telepharmacy network
 Other hospitals will provide this or similar
services
 As pharmacists retire in rural settings,
expansion may include full time telepharmacy
coverage
 The servicing of hospitals by community
pharmacists without needing to be on site
Hospital Telepharmacy
Network (as of 9/1/06)
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Heart of America Medical Center, Rugby
Mercy Hospital, Devils Lake
St. Aloisius Hospital, Harvey
Towner County Medical Center, Cando
Presentation Medical Center, Rolla
Carrington Health Center, Carrington
SCCI Hospital, Mandan
Conclusion
 Telepharmacy is a way to provide superior
pharmacy services to rural ND
 Telepharmacy is adaptable to a wide range of
practice settings
 This is only the tip of the iceberg in terms of
possibilities
RESOURCES
Ann Rathke, Telepharmacy Coordinator
NDSU College of Pharmacy, Nursing, and
Allied Sciences
123 Sudro Hall
Fargo, ND 58105
701-231-5863
[email protected]
RESOURCES
Howard Anderson, Executive Director
North Dakota Board of Pharmacy
PO Box 1354
Bismarck, ND 58502-1354
701-328-9535
[email protected]
RESOURCES
John Skwiera, R.Ph.
Heart of America Medical Center
800 South Main
Rugby, ND 58368
701-776-5261, ext 2262
[email protected]
Telepharmacy Equipment
Ryan Jilek
Custom Data, Inc.
677 10th Street East
Dickinson, ND 58601
701-483-3036
www.telepharmacyconcepts.com
www.customdata.com
[email protected]