Current practices and state regulations regarding telepharmacy in rural hospitals

Casey, Michelle; Sorensen, Todd D.; Elias, Walter S.; Knudson, Alana; Gregg, Walter

doi:10.2146/ajhp090531

Cited by 54 publications

(61 citation statements)

References 14 publications

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“…44 (Currently, telepharmacy is applied to serve remote rural areas, but it may not be limited to rural areas in the future. ), [44][45][46][47][48] • Reconcile medications, 49 • The ASHP Long-Range Vision for the Pharmacy Work Force in Hospitals and Health Systems anticipated that some pharmacy technicians will manage medication supply logistics. 13 While advocating for new models for health-system pharmacy services and for appropriate regulatory provisions, health-system pharmacists should be careful to preserve the freedom to experiment and innovate with respect to the roles of pharmacy technicians.…”

Section: Novel Roles For Pharmacy Techniciansmentioning

confidence: 99%

Opportunities and challenges related to pharmacy technicians in supporting optimal pharmacy practice models in health systems

Myers

2011

American Journal of Health-System Pharmacy

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Section: Novel Roles For Pharmacy Techniciansmentioning

confidence: 99%

Opportunities and challenges related to pharmacy technicians in supporting optimal pharmacy practice models in health systems

Myers

2011

American Journal of Health-System Pharmacy

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“…Previous studies have focused on describing telepharmacy activities in a small number of hospitals 5,8,[13][14][15][16][17][18][19][20][21] or in a single hospital. 22,23 Studies have reported the impact of telepharmacy by tracking medication error rates, 4 by describing pharmaceutical care activities focused on drug-related problems, 5 by evaluating number of orders reviewed, modified, discontinued, and voided by remote pharmacists, 9 by describing the 24-h pharmacy staffing coverage given, 15 or…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Telepharmacy, which is a subset of telemedicine, may be useful for improving pharmacy service coverage regardless of where the pharmacist is located. [2][3][4] Telepharmacy applies to activities including a combination of electronic data entry, prescription order verification, centralized anticoagulation clinics, online benefit adjudication, medication dispensing, and telehealth consultation with medication use evaluation using computer technology. 1,2 Several rural hospitals in the United States 4 and Australia 5 have implemented telepharmacy services that allow for 24-h pharmacist review of all medication orders.…”

mentioning

confidence: 99%

“…[2][3][4] Telepharmacy applies to activities including a combination of electronic data entry, prescription order verification, centralized anticoagulation clinics, online benefit adjudication, medication dispensing, and telehealth consultation with medication use evaluation using computer technology. 1,2 Several rural hospitals in the United States 4 and Australia 5 have implemented telepharmacy services that allow for 24-h pharmacist review of all medication orders. In the United States, rural hospitals with or without on-site hospital pharmacists were incentivized by regulatory mandates from the Centers for Medicare and Medicaid Services and other regulatory agencies 6 to use computers and health information technology (HIT) as a vehicle for providing convenient and affordable pharmacy service solutions to meet patient needs.…”

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confidence: 99%

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A Retrospective Evaluation of Remote Pharmacist Interventions in a Telepharmacy Service Model Using a Conceptual Framework

Sankaranarayanan

Murante

Moffett

2014

Telemedicine and e-Health

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Objectives: This retrospective cross-sectional study evaluated a telepharmacy service model using a conceptual framework to compare documented remote pharmacist interventions by year, hospital, and remote pharmacist and across rural hospitals with or without an onsite rural hospital pharmacist. Materials and Methods: Documented remote pharmacist interventions for patients at eight rural hospitals in the Midwestern United States during prospective prescription order review/entry from 2008 to 2011 were extracted from RxFusion Ò database (a home-grown system, i.e., internally developed program at The Nebraska Medical Center (TNMC) for capturing remote pharmacistdocumented intervention data). The study authors conceptualized an analytical framework, mapping the 37 classes of remote pharmacist interventions to three broader-level definitions: (a) intervention, eight categories (interaction/potential interaction, contraindication, adverse effects, anticoagulation monitoring, drug product selection, drug regimen, summary, and recommendation), (b) patient medication management, two categories (therapy review and action), and (c) health system-centered medication use process, four categories (prescribing, transcribing and documenting, administering, and monitoring). Frequencies of intervention levels were compared by year, hospital, remote pharmacist, and hospital pharmacy status (with a remote pharmacist and on-site pharmacist or with a remote pharmacist only) using chisquared test and univariate logistic regression analyses, as appropriate.Results: For 450,000 prescription orders 19,222 remote pharmacist interventions were documented. Frequency of interventions significantly increased each year (36% in 2009, 55% in 2010, and 7% in 2011) versus the baseline year (2008, 3%) when service started. The frequency of interventions also differed significantly across the eight hospitals and 16 remote pharmacists for the three defined intervention levels and categories. Remote pharmacist interventions at hospitals with an on-site and remote pharmacist (n = 12,141) versus those with a remote pharmacist alone (n = 7,081) were significantly more likely to be (1) patient-centered, (2) related to ''actionable'' medication management recommendations (unadjusted odds ratio [OR] = 1.12), and (3) related to the ''transcribing'' (OR = 1.47) and ''prescribing'' (OR = 1.40) steps of the health system-centered medication use process level (all p < 0.01). Conclusions: This is one of the first studies to demonstrate the patient-and health system-centered nature of pharmaceutical care delivered via a telepharmacy service model by evaluating documented remote pharmacist interventions with an analytical framework.

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“…12 Although it may be impractical for most rural hospitals to implement many of the costly, labor-intensive processes used at urban hospitals, telemedicine can offer a practical, cost-effective alternative. 5,17,18 …”

Section: Introductionmentioning

confidence: 99%

Rural Inpatient Telepharmacy Consultation Demonstration for After-Hours Medication Review

Cole

Grubbs

Din

et al. 2012

Telemedicine and e-Health

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Objective: Medication errors contribute to a significant number of fatal and nonfatal adverse medical events each year. Many actions, from both a policy and innovation standpoint, have been taken to reduce medication errors in the inpatient setting; yet, these actions often target larger urban hospitals. Rural hospitals face many more challenges in implementing these changes due to fewer resources and lower patient volumes. Our article discusses the implementation and results of a telepharmacy demonstration implemented between the University of California Davis Health System and six rural hospitals. Materials and Methods: A retrospective chart review obtained baseline medication errors for comparison with the prospective review of medication orders through telepharmacy. Medication orders from rural hospitals were transmitted via fax to the University of California Davis Pharmacy for after-hours review. If a medication required afterhours removal from the pharmacy, it was requested that video verification by a telepharmacist be used to verify that the correct medication was removed from the pharmacy. Results: Baseline findings from the retrospective chart review indicated that 30.0% of patients had one or more medication errors and that these errors occurred in 7.2% of the medication orders. None of these errors were found to have resulted in harm to the patients. During the telepharmacy demonstration, 2,378 medication orders were screened from 504 independent order review requests. In total, 58 (19.2%) patients had one or more medication errors. The errors from the telepharmacy demonstration represented potential errors that were identified through telepharmacy medication review. Conclusions: Telepharmacy represents a potential alternative to around-the-clock on-site pharmacist medication review for rural hospitals.

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Current practices and state regulations regarding telepharmacy in rural hospitals

Abstract: The application of telepharmacy in rural hospitals varies across the United States but is not widespread, and many states have not defined regulations for telepharmacy in hospitals.

Cited by 54 publications

References 14 publications

Opportunities and challenges related to pharmacy technicians in supporting optimal pharmacy practice models in health systems

Opportunities and challenges related to pharmacy technicians in supporting optimal pharmacy practice models in health systems

A Retrospective Evaluation of Remote Pharmacist Interventions in a Telepharmacy Service Model Using a Conceptual Framework

Rural Inpatient Telepharmacy Consultation Demonstration for After-Hours Medication Review

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