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How to become a 'virtual' pharmacy with technology

Accreditation Connection, November 12, 2004

When JCAHO surveyors inspected Hendry Regional Medical Center in Clewiston, FL, in January, they liked what they saw.

The 66-bed hospital has two pharmacists and two pharmacy technicians working a little more than eight hours a day. In 2001 and 2002, 34% of medication errors reported at the hospital involved the selection of the wrong drug at night, after the pharmacy closed, says pharmacy services director Sandy Woodall, PharmD.

The hospital teamed with the Dublin, OH-based Cardinal Health and its Rxe-sourceSM remote medication-order review service. Once pharmacists began reviewing orders after-hours, the wrong-drug error percentage dropped to 15%. Woodall then approached Cardinal Health about using a digital camera so nurses could photograph the drug they wanted to administer, send it to an Rxe-source regional call service center, and pharmacists there could verify whether it was the correct drug.

Once they started using the digital-camera technology, the wrong-drug error percentage dropped to zero. "This has provided a huge impact on patient safety for us," Woodall says. "We've been able to become a virtual 24-hour pharmacy."

Because two-thirds of all U.S. hospitals do not have 24-hour pharmacy coverage, remote medication-order review-or telepharmacy-can help alleviate staffing shortages, prevent medication errors, and meet JCAHO requirements.

JCAHO standard MM.4.10 requires that a qualified healthcare professional review medication orders in the pharmacist's absence if the pharmacy is not open 24 hours. The JCAHO also requires pharmacists to review any after-hour orders once the pharmacy opens.

How the service works

The Cardinal Health system impressed the JCAHO so much that it requested that the hospital submit a manuscript detailing its experience with telepharmacy, Woodall says. The hospital received no requirements for improvement in medication management, she says.

Cardinal Health's Rxe-source service works as follows:

* Nurses at the hospital fax an order to a call service center

* Pharmacists review the order, asking for clarifications or making interventions if necessary

* Pharmacists fax the order back to the hospital or enter it into the hospital's automated dispensing system through a secure Internet connection

* Pharmacists at one of five call service centers across the country can process an order in less than 60 minutes, says Rxe-source General Manager Ron Graham. Pharmacists can process STAT, or urgent, orders in 15-20 minutes.

A surveyor during one Texas hospital's site visit watched as a Cardinal Health Rxe-source pharmacist called a nurse and said he needed to contact the physician because of a possible interaction with the medication ordered and another drug listed on the patient's profile. The conversation impressed the surveyor, Graham says.

"They said, 'Wow, every small hospital should have this,' " Graham says of the telepharmacy solution.

Cardinal Health has offered Rxe-source on a national basis since July 2003. Laurel, MD-based MedNovations and its PharmaChekSM After Hours-a service similar to Rxe-source-arrived on the scene in February 2000.

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