REMOTE MEDICATION ORDER ENTRY
in
Rural Minnesota
by:
Mike Dudzik RPh, MHA
Minnesota Rural Health
Conference Smart Health 2006:
Focus on Technology
OUR PARTNERS
SISU MEDICAL SYSTEMS
• A consortium of 14 rural healthcare
facilities
• They work together as non-profits to share
IT resources
2
OUR PARTNERS
3
OUR PARTNERS
4
WILDERNESS HOSPITALS
1.
2.
3.
4.
5.
6.
7.
8.
Mercy Hospital in Moose Lake
Riverwood Healthcare Center in Aitkin
Community Memorial Hospital in Cloquet
Lakeview Memorial Hospital in Two Harbors
Cook Hospital in Cook
Deer River Health Center in Deer River
Big Fork Valley Hospital in Big Fork
Ely-Bloomenson Hospital in Ely
5
GOALS
• Learning about our partners
• To discuss the AHRQ grant process
• To explain the components of the grant
• To understand the difference between telepharmacy
and After Hours Order Entry
• To explain the Board of Pharmacy’s position
6
GOALS
• For hospital administration to better understand why this
is not just “another” expense
• To understand the nuts and bolts of this service
• How after hours and telepharmacy do improve patient
safety while reducing medication errors
• How will we measure this improvement in safety
7
GOALS
• Are After Hours OE and/or telepharmacy needed in
LTC settings also?
8
THE GRANT PROCESS
• AHRQ: Planning and an IT Grant
• A grant writer from Health Planning and
Management Resources was hired
• Administrators from the Wilderness Hospitals,
St Luke’s, UMD and SISU met many times
• The grant provided $1.5 Million to be matched
by the participating hospitals and partners
9
COMPONENTS OF THE GRANT
1.
2.
3.
4.
5.
6.
After Hours Order Entry
Telepharmacy video cameras
Vacation replacement for pharmacists
CEU’s via videoconferencing
POS bedside barcode scanning
A QA tool to measure improvement in safety
10
TELEPHARMACY VS AFTER HOURS
• Telepharmacy involves the use of video cameras to
verify medication orders, drug package sizes, strength
correctness, to identify a dosage form or to fill “retail”
prescriptions at remote sites
Example: No Dakota College of Pharmacy
• After Hours Remote Order Entry is the process
where a “hub” hospital pharmacy department enter
medication orders directly into the remote hospital’s PIS
11
BOARD OF PHARMACY
• The current pharmacist shortage is severe nationally and
most severe in rural communities
• Many rural hospitals do not have a FT pharmacist
• Some have coverage from several hours, up to 12 or more
hours daily, no coverage on weekends, nights or holidays
• Pharmacy Boards see After Hours and telepharmacy as a
means to address a dangerous lack of pharmacist
manpower and to improve the safety of patients
12
BOARD OF PHARMACY
REQUIRES:
• Annual variance
• HIPPA Business Associates agreement
• Hub and remote sites policies and procedures
• Copy of each sites drug formulary
• Pharmacist final review of order and patient profile
• Measurement of quality provided
• Not a replacement for vacations or sick time
• Hours of operation
13
ASHP AND JCAHO PROPOSAL
States:
That when a health care facility’s on-site pharmacy is
open less than 24 hours a day, the hospital makes
arrangements for a pharmacist review of all
medication orders when their pharmacy is closed.
Currently the requirement specifies that a “qualified”
health care professional review the orders in the
pharmacists absence.
14
NUTS AND BOLTS OF AFTER HOURS
•
•
•
•
•
•
Utilizing the same Meditech IT platform- advantages
Performing the service out of a 24/7 hospital pharmacy
Specially trained certified pharmacy OE technicians
Additional pharmacist staff added during critical hours
Cross utilization of all pharmacy staff for productivity
“Emergency” use of pharmacists at home for OE
15
NUTS AND BOLTS
• Keep the service affordable and flexible for members
$8-12.00 per hour based on volume
• Currently After Hours enters:
90-300 orders per day
4000 orders per month
• St Luke’s keeps a notebook for each hospital with
order sets, preferences, etc for reference
• Currently testing telepharmacy video equipment
• Developing website for all hospitals to share
16
MEDICATION SAFETY IMPROVED
• A pharmacist reviews/approves all medication orders
when the remote pharmacy is closed
• Nursing has direct access to a hospital trained
pharmacist 24/7
• 5 R’s of medication administration are verified
• Allergies checked against patient’s current meds
17
MEDICATION SAFETY IMPROVED
•
•
•
•
•
•
Food drug allergies are checked
Elimination of drug class duplications of therapy
Drug appropriateness verified
Medication and IV labels can be printed by hub
Automatic printing of computerized MARs by hub
Timely review of orders prior to administration
Goal= 15-45 minutes
• Use of “clinical messages” for communication and QA
measurement
18
QUALITY MEASUREMENT BY UMD
“Quality Assurance” survey will measure:
• Any change in medication error rate
• Any time lag between orders written and
administered
• The level of staff satisfaction with after hours service
versus normal hours of operation
• The quantitative and qualitative measurement of
clinical interventions
• Any change in appropriate drug use and dosing
• Any change in “first doses” given before RPh review
19
OTHER OPPORTUNITIES
• Is there a need telepharmacy for small towns with limited
drug stores and/or hours of operation?
• Is After Hours OE only needed during certain hours?
• Is After Hours OE needed for LTC facilities?
• Should we combine our resources to create a Minnesota
“hub OE center” for telepharmacy and After Hours OE for
all of Minnesota?
• Can pharmacists work with the BOP to allow After Hours
OE from pharmacists at home?
20
OTHER OPPORTUNITIES
• Keep the service fees affordable without losing
money
• Keep our services housed in Minnesota
• Standardize the definition and measurement of
“quality”
21
OTHER PROVIDERS
•
Rx e-source by Cardinal Health- 4 regional
hubs in the USA (non-hospital based)
•
Fairview Northland Hospital currently does OE for Fairview Red Wing
(hospital based)
Bruce Thompson, RPh,MS
bthomps4@fairview.org
763-389-6625
•
E-PharmPro,Inc currently recruiting and advertising in
Minnesota
www.pharmPro-Inc.com
800-659-7440
22
FOR MORE INFORMATION
Mike Dudzik, RPh, MHA, Dir of Pharmacy
St Luke’s Hospital Duluth, MN 55811
mdudzik@slhduluth.com
218-249-5621
23
THANK YOU!
24
TelePharmacy in Minnesota
Many Models
After hours order entry is a good
thing for a small hospital
Pharmacist
• Medication orders are reviewed and
entered into our patient care system
• Allergies are entered, MAR’s are printed,
problems orders are handled if necessary
• Morning “clean up” is much quicker
• Patients get morning meds sooner
26
Pharmacy Automation makes it
better
• We don’t have Acudose/Pyxis/Omnicell
cabinets
• With cabinets nurses rarely needs to
enter Pharmacy at night
• New JCAHO medication standard July 1
2006
• Only Pharmacists may enter Pharmacy
27
Accurate MARs
• Computer generated Medication
Administration Records are priceless to
Nursing after hours
• Clinical notes appear on MARs to get
problem orders clarified
28
TelePharmacy models in MN
• Mostly retail Pharmacies
• Technician at remote site with drugs
• Audio and Video connection to main
Pharmacy
• Usually share computer system with main
Pharmacy
• Pharmacist does drug use review and
checks med and label
29
TelePharmacy models in MN
• Usually low volume remote sites
• Some remote sites have prepacked med
that are released from cabinet by main
Pharmacy
• Drop stations where prescriptions are
picked up and patients counseled face to
face or by phone
30
TelePharmacy models in MN
• Prepacked meds are taken to remote
clinic sites and dispensed by
Physicain/provider
• Instymed machines in ERs and clinics are
considered Physician dispensing
31
Board of Pharmacy
Our primary role is to protect the public
Telepharmacy should not replace the face
to face interactions of a Pharmacist and
patient.
Technology and the marketplace change
much faster than legislation and
regulation
32
Thank You
33