value of and opportunities for pharmacist

5/7/2012
THE VALUE OF AND OPPORTUNITIES FOR PHARMACIST PROSPECTIVE REVIEW OF MEDICATION ORDERS
Mark J. Hardy, Pharm D
Assistant Executive Director
ND Board of Pharmacy
Susan Schnase, R.Ph., MMgt.
Director for Pharmacy Service
Sanford Health, Fargo Region
Shelley Johnsen, R.Ph.
Director
ePharmacist Direct
Marsha Waind, M/OTR
Manager
Regional Services, Altru Health System
Ann Rathke, MA, MEd
Telepharmacy Coordinator
NDSU College of Pharmacy, Nursing, and Allied Sciences
North Dakota Board of Pharmacy:
Hospital First Dose Review
A hospital pharmacy must have a pharmacist review all medication orders prior to the first dose being administered to the patient. Policies and procedures should be put into place to come to compliance.
Background
Many of our small facilities across the state are not able to staff their hospital with a pharmacist for the review of medications at all times.
The Board has been discussing the implementation of this rule for a extensive period of time.
Background
Approximately half of all medication errors occur in the prescribing stage of the medication use process.
Pharmacist review of medication order reduces these error and bring a level of expertise to the hospital setting that is imperative for the highest quality patient care.
Hospital First Dose Review
• Rule drafted in late 2011, published in the Board of Pharmacy’s newsletter for notification
• Presented to the American Society of Health System Pharmacists and the ND Pharmacists Association for review
• Rule hearing held April 14, 2012, at the ND Pharmacist Association Convention 1
5/7/2012
Exemptions to Rule
Use of Telepharmacy to Comply
This provision does not apply when:
• For many of the small and rural hospitals the • The practitioner is directly involved in the administration
• Emergency room, operating room, endoscopy
suite, etc.
• In the cases of “stat” order or when the clinical status would be compromised by the delay of the pharmacist’s review
Use of Telepharmacy to Comply
• We have had good feedback from the facilities that have implemented telepharmacy systems regarding the benefit to establishing pharmacy services at all times and the enhanced level of care that patients are receiving.
• There are currently 4 providers of hospital telepharmacy services in North Dakota.
Level of Care
• The Board of Pharmacy feels strongly about use of telepharmacy will be the method to comply with the rule.
• Currently, we have around 20 hospitals that have come to compliance, many of which use telepharmacy. Cost of Telepharmacy
• The Board of Pharmacy recognizes the added cost that a facility will bear to come to compliance with this rule.
• If the rule passes, we intend to allow a grace period to implement the policies and procedures.
e‐Pharmacist Direct: Hospital Telepharmacy
An Evolution in Patient Care
the benefit of requiring first dose review in our hospitals and establishing pharmacy services in facilities that currently have limited pharmacy services due to cost and labor restraints.
• If the rule is passed, North Dakota will be the first state to require first dose review by a pharmacist in hospitals.
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Lessons Learned
 Standard medication management process is critical
Results: Override Reduction
• Mercy Hospital, Devils Lake, ND
• November 2008 – January 2010
 Integration of technology/automation determines efficiency
 Audio and visual technology
is essential  24/7 pharmacy access
motivates younger,
less‐experienced pharmacists
to take rural positions
Success Stories
• Late one night, a pharmacist at CHI’s Central
DEC
NOV
OCT
SEP
AUG
JUL
JUN
MAY
APR
MAR
FEB
JAN
2010
2009
2008
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
Altru Telepharmacy: Regional
Pharmacy Resources
Site Telepharmacy reviewed a medication
order for a one‐year‐old patient and realized
the medication could cause a potentially
fatal respiratory depression. • On the pharmacist’s recommendation, the medication was not administered. In addition to this “good catch,” alerts were added to the hospital’s computer system so the staff is automatically alerted to a warning anytime the medication is ordered.
• The pharmacist’s quick action ensured the safety of a young patient and protected future patients, too.
Goal: Provide hospital pharmacy resources
and professional support to networking
CAH’s within the Altru Region
To assure 24/7 pharmacist coverage, Altru
Hospital Pharmacy will offer pharmacist oversight of medication orders via use of video conferencing systems between Altru
and the rural hospital. Barriers • Require installation of video equipment to be located in the Altru hospital central pharmacy; train multitude of hospital pharmacists
• Will not intrude on rural support of small town pharmacists and the services they provide to rural facilities but seek opportunities to enhance
services that enhance transfers and patient care
• Not all Altru pharmacists are MN licensed
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5/7/2012
Opportunities
• Establish closer relationships and networking with regional facilities bringing Altru Health System’s responsive and supportive nature to the forefront
• Enhance Altru’s awareness of regional rural hospital’s pharmacy situation and needs
• Through improved knowledge of rural hospital pharmacy capabilities, patient‐related transfers situations between facilities will be improved
Sites of Service
• First Care Hospital – Park River
• Towner Co Hospital – Cando
• Cavalier Co Hospital ‐ Langdon
• Pembina Co Hospital – Cavalier*
• Unity Hospital – Grafton*
• Cooperstown Hospital – Cooperstown*
• Nelson Co Hospital – McVille*
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5/7/2012
Sanford Health Objectives
SANFORD HEALTH
One Chart (Epic)
Sanford Health Solution
• Implement One Chart (Epic), eMAR and CPOE system‐wide
• Maximize patient safety • Provide access to pharmacists 24 X7
Sanford Health Results
• Implemented One Chart (Epic) in over 20 hospitals to date
• Partner with Cardinal Health to provide pharmacist remote order and verification services
• Coverage provided to sites in SD, ND, IA and MN
• Additional sites being added
Ann Rathke, NDSU College of Pharmacy, Nursing, and Allied Sciences
[email protected]
Mark J. Hardy, North Dakota Board of Pharmacy
[email protected]
Shelley Johnsen, ePharmacist Direct
[email protected]
Marsha Waind, Altru Regional Services
[email protected]
Jeff Zak, Altru Pharmacy [email protected]
Susan Schnase, Sanford Health
[email protected]
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