Telepharmacy is a viable option for rural hospitals that receive medication requests when no on-site pharmacist is available, according to the results of a study published in the September 2012 issue of Telemedicine and e-Health
. Rural hospitals have trouble obtaining expensive equipment to help reduce medication errors and often do not have the patient volumes to justify a full-time pharmacist.
Researchers from the University of California (UC) Davis School of Medicine and the University of Utah School of Medicine explored a proof-of-concept telepharmacy model between the UC Davis Medical Center Pharmacy and 6 rural California hospitals. Researchers visited each hospital to gauge hospital and hospital pharmacy services and to meet with the on-site pharmacist.
They also collected baseline data on medication errors at 5 of the 6 sites. Baseline findings showed that 30% of patients had 1 or more medication errors, with the errors occurring in 7.2% of medication orders. None of the medication errors resulted in serious harm.
On-site training with the system occurred a week prior to each site’s telepharmacy launch. Noting the technology and financial constraints at certain facilities, researchers used fax transmission to submit after-hours medication orders to the UC Davis Medical Center Pharmacy. Documents submitted included a patient cover sheet with relevant prescribing information, a list of active medications, and the new prescription order.
UC Davis pharmacists remotely verified medication dispensing when the on-site pharmacist was not present. After reviewing the initial medication order, pharmacists at UC Davis Medical Center screened for drug interactions and allergies and faxed the order back with medication approval or denial. If medication was required immediately, pharmacists and nurses would use real-time video conferencing to confirm the proper medication was taken from the pharmacy.
During the telepharmacy pilot program, UC Davis pharmacists screened 2378 medication orders from 504 order requests. The telepharmacy program identified 58 patients with 1 or more medication errors, which amounted to 19.2% of enrolled patients and a total of 97 medication errors. The most common errors included incorrect doses, routes of administration, and allergy indications, as well as omitted dosing or medication amounts. UC Davis pharmacists also reviewed 65 medications through video conferences during the program, and reported identifying 2 medication errors that were related to incorrect medication strengths.
To minimize work flow disruptions, researchers noted that a rolling expansion, where sites added more patients as hospital staff grew more comfortable with the workload adjustments, helped assist hospitals with the system.