Download Remote 24 hour Pharmacy Service

Remote 24 hour
Pharmacy Service
From 40 Feet to 40 Miles
200 Miles
Bruce Thompson, MS,RPh Fairview Northland
Faculty Disclosure
- Faculty has nothing to disclose.
Fairview Care Systems
Northland
Lakes
Southdale
University
Ridges
Range - Hibbing
Red Wing
22
Northland Medical Center
• Announced in December 04 as a Proposed Rule
Change in 2006. Still No official position.
• MM.4.10 as of July 2006
– All prescriptions or medication orders are reviewed for
appropriateness.
– When an on-site licensed pharmacy is not open 24
hours a day, 7 days a week, a health care professional
determined to be qualified by the hospital reviews the
medication order in the pharmacist’s absence. .
ASHP Urges Members to Support
JCAHO Proposed Medication
Management Standards
• The proposed revision to the standards, which
were announced on Dec. 9,2004 includes the
requirement that "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
during these hours."
A policy statement approved by
ASHP members during the 2003.
• 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 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 promote the importance of pharmacist access to pertinent
patient information, regardless of proximity to patient.
Northland RN to Lakes RPh back
to Northland RN
• Benefits include:
– timely review of medications by a pharmacist
• Duplicate orders,
• interactions,
• appropriateness,
• allergies
• entry of Medication orders in computer
system.
– Providing Computerized MAR’s
Why it Worked so Well !!
• Both pharmacies use the Same Computer System WORX
– Lakes has access to Northland Patients.
Enter orders as if at Northland.
• Both Hospitals have Profile Pyxis
• Both Hospitals use the Same format for
computerized MAR
• Lakes Night Pharmacists are Quality
Pharmacists
WORKLOAD
• June 2004 First Month
– 802 orders, Average of 27 per night
• Split equally throughout the Night
• September 2004 the Fourth Month
– 672 orders, Average of 22 per night
• Split equally throughout the Night
Pharmacy Interventions
Non Patient
Safety
Count Percentage
Patient
Safety
Patient
Safety
Non
Patient
Safety
Total
65
63.7%
37
36.3%
102
100%
Order Processing Time
65.1%
1000
800
23.5%
600
5.6%
400
4.1%
1.6%
200
0
< 15
min.
15-30
min.
30-45
min.
45-60
min.
> 60
min.
During a two-month time period, 89% of the Medication orders were
completed within 30 minutes. Orders over 30 minutes involved clarifications
or workload issues.
Where we are today
• Expand Fairview’s Model to other Hospitals
• Expansion of Pharmacy Services January -2006.
• Expanded Northland Hospital to 24 hr service
–Contracted Services with:
• Lakeview Hospital – Stillwater
• Fairview Red Wing Hospital
Why it Works so Well NOW!!
• Northland has access to their Patients.
– Enter orders into computer as if we are at the other
hospital.
– NOTE: Both hospitals have the same computer system,
however it is different than our system at Northland.
• Both Hospitals have Profile with Pyxis/ Omnicell
• Both Hospitals use the Same format for computerized
MAR
• Northland contacts Nursing/Providers with any issues.
Combined 24 hour Remote Time Study
May 2006 - 60 Patients
17%
Orders< 15 minutes
12%
Orders 16 -30 minutes
Orders 31-60 minutes
60%
12%
Orders Greater than 60
minutes
Lakeview Hospital Quality Audit
27%
Patient Safety
Items N=22
Non Patient Safety
n=8
73%
Lakeview Hospital Intervention Types
19%
Wrong Order,
31%
Clarify
4%
Missing info,
Patient or Drug
Other
15%
Allergy
31%
• Provides service to Two Harbors Hospital for past
few years.
– Current staff at Two Harbors is only a few hours a day.
• Expanded to Wilderness Hospital Group of NE
Minnesota Hospitals starting in summer of 2005.
• Minnesota Board Approval for Variance.
• All facilities share same computer System.
• Long range plan – provide service up to 10
hospitals.
• Virginia worked with the
Board of Pharmacy to get a
Variance. Started service in
November 2004.
• Pharmacy has been managed
By Cardinal (Owen Health
Care) Management for a
number of years.
• Service provided by a call
center in Illinois.
MinnesotaBoard of Pharmacy
• Variance required for Remote Pharmacy
Review.
• Application by the Receiving Hospital with
cooperation of the Providing Hospital.
• Generally the Board has been very supportive.
• Must meet criteria.
• http://www.phcybrd.state.mn.us/forms/Offsiteg.pdf
MinnesotaBoard of Pharmacy
• Guidelines for Remote Pharmacy Review.
– Not designed to be the only Pharmacist coverage at
the facility.
– Policy and Procedures for Remote Service.
– Hours of Operation.
– Copy of Formulary.
– Understand Pharmacy Practice at site.
– Complete review of Patients Profile.
Wisconsin Pharmacy
Examining Board
• Will not grant variance to Viking Fans !!
• Nothing in state law but they do grant
variances to Packer fans.
• No issues if part of a system.
• Have approved Cardinal Health
• Allow order review. Even Remote
dispensing and shuttle medications.
• Regulations to provide off-site preview and
verification by a pharmacist of patient-specific drugs
or devices ordered for a patient when the hospital
pharmacy is closed and address minimum standards
for the provision of these services. July 2005
– http://www.state.ia.us/ibpe/rules_laws/ch07.html
Chapter 7.7
How to Develop a Service !
• Medical & Nursing Staff Support
– Helps drive the service.
• Administrative Support
– Key for financial support
• Find Hospitals with similar services, size and
characteristics
How to Develop a Service
• Market your Service
– Presentations, Brochures, Direct Mailing, and Site Visits
• Evaluation of volumes and hospital characteristics.
–
–
–
–
–
Hours of Operation.
Minimum of 1 month volume
Orders, Admissions,
Hospital services, number of providers, etc.
Computer System and connectivity
How to Develop a Service
• Develop Contract between sites
– This may take a while, 1-3 months
• Understand the rules/regulations
– Each State Board of Pharmacy has differing biases
• Collect all the idiosyncrasies of new hospitals.
– Order Sets, special order entry processes
• Training at Site,
• On Site review of Process Introduction to staff
• Formulary Review
Understand your Business
How to Develop a Service
• Develop and Implement process
– Fax Orders to Pharmacy (Digital Image)
– Pharmacist reviews orders for accuracy, interactions,
appropriateness
– Order Entry
– Coordinates information with Nursing
– Print MAR’s / Release medications in ADM’s
How to Develop a Service
• Other Options
• Televideo to review medications or
preparations by Nursing
• Back up plan when computer access not
available.
– Fax back generic/brand name of medications
to reduce errors by nursing
Next Steps
Go Live !
• Continue Review of Process
–Improvements will be ongoing
–Quarterly Quality reports
• Pharmacy and Administration
Summary -How to Develop a Service
•
•
•
•
•
Medical / Nursing Staff and Administrative Support
Market and Coordinate with Hospitals
Develop Contract between sites
State Board of Pharmacy Approval (2-4 Months)
Implementation
– Training at Site,
• On Site review of Process
• Formulary Review
Introduction to staff
Understand your Business
– Computer Access
• Estimated costs $2500- $5000 per site
– Video Access ?
More Questions?
• Bruce Thompson, MS,RPh
Fairview Northland
[email protected]
763-389-6625
You spend a fair amount
of time at work..
Let’s make it enjoyable.