North Dakota Telepharmacy Project Hospital Telepharmacy Model

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North Dakota Telepharmacy ProjectHospital
Telepharmacy Model

• Slide presentation by John S. Skwiera, R.Ph.,
  Heart of America Medical Center, Rugby

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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!

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Automation

• Pyxis, Omnicell -- automated dispensing equipment
• Expensive
• Data entry with verification necessary
• Is not the answer to everything

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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

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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

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Why Do It?

• Maintaining quality of care
• Easing pharmacist shortages
• Improving of the pharmacists life
• Maintaining the bottom line
• Complying with regulations

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Pharmacist Demographics

• There are not enough pharmacists
• We cant burn out the pharmacists we have
• Pharmacists in many rural hospitals are aging
• Recruitment of young pharmacists to rural areas
  is lagging

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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

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Easing Pharmacist Shortages

• Telepharmacy may be the only feasible option for
• Emergency coverage
• After hours coverage
• Weekend coverage
• Vacation coverage
• Routine pharmacy operations

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Improving the Lives of Hospital Pharmacists

• Reducing stress
• Assisting in staff retention and recruitment
• Keeping open

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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

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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

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Telepharmacy in the Hospital Setting
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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

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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

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Telepharmacy Components

• Institutional component
• Hospital to hospital
• Community pharmacy to hospital
• Provides services between two sites for
  scheduled telepharmacy operations

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Telepharmacy Components

• Pharmacists home to institution for
  unscheduled absences of a pharmacist due to
  illness, inclement weather, etc.

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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)

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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

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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

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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

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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

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Recommended Reading

• Rural Hospitals and Telepharmacy by Petra S.
  Berger (Risk Management and Patient Safety
  Institute)
• www.rmpsi.com

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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 physicians order under the
  document camera and comparing it to the
  technicians computer entry

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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

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Who Sees What?

• Each pharmacist can have access to another sites
  pharmacy information system, as allowed by the
  software -- ideally, it would be compatible
• The pharmacist can view and approve a
  technicians work at the other sites, as allowed

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Evaluate
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Verify
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Identify Meds
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Pitfalls

• Institutional resistance
• Corporate resistance
• Staff resistance
• Lack of time to implement
• Lack of ongoing financial commitment
• Challenges in terms of systems compatibility and
  connectivity

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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

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Hospital Telepharmacy Network (as of 9/1/06)

• 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

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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

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RESOURCES

• Ann Rathke, Telepharmacy Coordinator
• NDSU College of Pharmacy, Nursing, and Allied
  Sciences
• 123 Sudro Hall
• Fargo, ND 58105
• 701-231-5863
• ann.rathke_at_ndsu.edu

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RESOURCES

• Howard Anderson, Executive Director
• North Dakota Board of Pharmacy
• PO Box 1354
• Bismarck, ND 58502-1354
• 701-328-9535
• ndpoph_at_btigate.com

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RESOURCES

• John Skwiera, R.Ph.
• Heart of America Medical Center
• 800 South Main
• Rugby, ND 58368
• 701-776-5261, ext 2262
• pharmacy_at_hamc.com

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Telepharmacy Equipment

• Ryan Jilek
• Custom Data, Inc.
• 677 10th Street East
• Dickinson, ND 58601
• 701-483-3036
• www.telepharmacyconcepts.com
• www.customdata.com
• jilek_at_customdata.com