Telepharmacy Really Does Make A DifferenceTelepharmacy Really Does Make A Difference

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Patient safety improves when telepharmacy services backstop clinicians in rural hospitals when their pharmacists are not on the premises, according to a new study. In a baseline sample, 30% of hospitalized patients had one or more errors in medications ordered after hours. But when orders were faxed to and screened by pharmacists at the University of California Davis Health System, the study found, the pharmacists caught errors in medications ordered for 19.2% of the patients.

"Telepharmacy represents a potential alternative to around-the-clock on-site pharmacist medication review for rural hospitals," concluded the paper in the journal Telemedicine and e-Health.

In fact, researchers from the UC Davis and the University of Utah Schools of Medicine noted that less than half of rural facilities have full-time pharmacists on staff; unsurprisingly, rural and critical-access hospitals have a higher incidence of medication errors than do other hospitals.

The UC Davis study involved six rural hospitals located between 70 and 230 miles from the academic medical center. Baseline data was collected on 70 patients at five of the facilities, and the six hospitals together referred orders for 302 telepharmacy patients to UC Davis pharmacists during the study period. Most of the errors caught by pharmacists during the study were minor, but a few could have caused serious harm to patients if they hadn't been prevented, the researchers said.

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When a medication was ordered for a patient in the study, nurses at the rural facilities sent a fax to the UC Davis pharmacists. The fax included the medication order, a list of active medications for the patient, and a cover sheet that had the patient's name, weight, and allergies. If the reviewing pharmacist needed more information, he or she had to call the hospital to get it.

Glen Moy, senior program officer for the California Healthcare Foundation, which funded the study, told information Healthcare that he was struck by the use of faxes to communicate with the pharmacists. "If we could get to the point where that information was available electronically, it would be much easier," he noted.

Another part of the study involved having the pharmacists use video cameras located in the rural facilities to verify that the appropriate medication had been removed from the pharmacy. But only 65 medications were verified visually by the remote pharmacists, mostly at one hospital that required nurses to submit to this process. Two dosage errors were identified as a result.

The number of patients in the study was limited partly because of workflow issues in the rural hospitals. But UC Davis had difficulty in coping with even the number of review requests it received because it couldn't recruit extra pharmacists to participate in the study--a problem it blamed on the pharmacist shortage in the U.S. Consequently, the medical center's regular pharmacists had to do the reviewing in addition to their regular duties.

Moy agreed that pharmacists are in short supply. But in his view, the application of telepharmacy should not have to depend on pharmacy schools ramping up to turn out more graduates. "The solution might be in using technology more effectively," he said.

For example, he speculated, bigger hospitals in California could form a telepharmacy network to handle reviewing requests. That way, if one medical center couldn't spare a pharmacist at a particular time, a pharmacist in some other hospital could review the order. "All of those hospitals together could provide the bandwidth or capacity." It might even be possible, he said, to enlist hospitals in other states.

Moy also pointed out that providers can use telehealth for other purposes besides reviewing medication orders, such as getting consults from specialists.

"It's a matter of effectively utilizing limited resources and expertise. And it's not just about rural areas. There are urban communities that have limited access to pharmacists and other providers. All these tele-technologies are potential solutions for those communities as well."

The California Healthcare Foundation recently invested in a telepharmacy firm called Pipeline that has also received some private equity investment. Noting that UC Davis couldn't keep its service going because of the cost, Moy said he's heard that Pipeline's technology is less expensive. "This is the private sector stepping in to find a lower-cost solution," he said.

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