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Remote 24 hour Pharmacy Service From 40 Feet to 40 Miles 200 Miles Bruce Thompson, MS,RPh Fairview Northland. Faculty Disclosure. - Faculty has nothing to disclose. Fairview Care Systems. Northland Lakes Southdale University Ridges Range - Hibbing Red Wing.
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Remote 24 hour Pharmacy Service From 40 Feet to 40 Miles 200 MilesBruce Thompson, MS,RPh Fairview Northland
Faculty Disclosure - Faculty has nothing to disclose.
Fairview Care Systems Northland Lakes Southdale University Ridges Range - Hibbing Red Wing 22
Announced in December 04 as a Proposed Rule Change in 2006. Still No official position. • MM.4.10 as of July 2006 • All prescriptions or medication orders are reviewed for appropriateness. • When an on-site licensed pharmacy is not open 24 hours a day, 7 days a week, a health care professional determined to be qualified by the hospital reviews the medication order in the pharmacist’s absence. .
ASHP Urges Members to Support JCAHO Proposed Medication Management Standards • The proposed revision to the standards, which were announced on Dec. 9,2004 includes the requirement that "when an on-site licensed pharmacy is not open 24 hours a day, seven days a week, the organization must make arrangements for a pharmacist's review during these hours."
A policy statement approved by ASHP members during the 2003. • To advocate alternative methods of pharmacist review of medication orders (such as remote review) before drug administration when onsite pharmacist review is not available; further, • To support the use of remote medication order review systems that communicate pharmacist approval of orders electronically to the hospital's automated medication distribution system; further, • To promote the importance of pharmacist access to pertinent patient information, regardless of proximity to patient.
Northland RN to Lakes RPh back to Northland RN • Benefits include: • timely review of medications by a pharmacist • Duplicate orders, • interactions, • appropriateness, • allergies • entry of Medication orders in computer system. • Providing Computerized MAR’s
Why it Worked so Well !! • Both pharmacies use the Same Computer System - WORX • Lakes has access to Northland Patients. Enter orders as if at Northland. • Both Hospitals have Profile Pyxis • Both Hospitals use the Same format for computerized MAR • Lakes Night Pharmacists are Quality Pharmacists
WORKLOAD • June 2004 First Month • 802 orders, Average of 27 per night • Split equally throughout the Night • September 2004 the Fourth Month • 672 orders, Average of 22 per night • Split equally throughout the Night
Where we are today • Expand Fairview’s Model to other Hospitals • Expansion of Pharmacy Services January -2006. • Expanded Northland Hospital to 24 hr service • Contracted Services with: • Lakeview Hospital – Stillwater • Fairview Red Wing Hospital
Why it Works so Well NOW!! • Northland hasaccess to their Patients. • Enter orders into computer as if we are at the other hospital. • NOTE: Both hospitals have the same computer system, however it is different than our system at Northland. • Both Hospitals have Profile with Pyxis/ Omnicell • Both Hospitals use the Same format for computerized MAR • Northland contacts Nursing/Providers with any issues.
Provides service to Two Harbors Hospital for past few years. • Current staff at Two Harbors is only a few hours a day. • Expanded to Wilderness Hospital Group of NE Minnesota Hospitals starting in summer of 2005. • Minnesota Board Approval for Variance. • All facilities share same computer System. • Long range plan – provide service up to 10 hospitals.
Virginia worked with the Board of Pharmacy to get a Variance. Started service in November 2004. • Pharmacy has been managed By Cardinal (Owen Health Care) Management for a number of years. • Service provided by a call center in Illinois.
MinnesotaBoardof Pharmacy • Variance required for Remote Pharmacy Review. • Application by the Receiving Hospital with cooperation of the Providing Hospital. • Generally the Board has been very supportive. • Must meet criteria. • http://www.phcybrd.state.mn.us/forms/Offsiteg.pdf
MinnesotaBoardof Pharmacy • Guidelines for Remote Pharmacy Review. • Not designed to be the only Pharmacist coverage at the facility. • Policy and Procedures for Remote Service. • Hours of Operation. • Copy of Formulary. • Understand Pharmacy Practice at site. • Complete review of Patients Profile.
Wisconsin Pharmacy Examining Board • Will not grant variance to Viking Fans !! • Nothing in state law but they do grant variances to Packer fans. • No issues if part of a system. • Have approved Cardinal Health • Allow order review. Even Remote dispensing and shuttle medications.
Regulations to provide off-site preview and verification by a pharmacist of patient-specific drugs or devices ordered for a patient when the hospital pharmacy is closed and address minimum standards for the provision of these services. July 2005 • http://www.state.ia.us/ibpe/rules_laws/ch07.html Chapter 7.7
How to Develop a Service ! • Medical & Nursing Staff Support • Helps drive the service. • Administrative Support • Key for financial support • Find Hospitals with similar services, size and characteristics
How to Develop a Service • Market your Service • Presentations, Brochures, Direct Mailing, and Site Visits • Evaluation of volumes and hospital characteristics. • Hours of Operation. • Minimum of 1 month volume • Orders, Admissions, • Hospital services, number of providers, etc. • Computer System and connectivity
How to Develop a Service • Develop Contract between sites • This may take a while, 1-3 months • Understand the rules/regulations • Each State Board of Pharmacy has differing biases • Collect all the idiosyncrasies of new hospitals. • Order Sets, special order entry processes • Training at Site, • On Site review of Process Introduction to staff • Formulary Review Understand your Business
How to Develop a Service • Develop and Implement process • Fax Orders to Pharmacy (Digital Image) • Pharmacist reviews orders for accuracy, interactions, appropriateness • Order Entry • Coordinates information with Nursing • Print MAR’s / Release medications in ADM’s
How to Develop a Service • Other Options • Televideo to review medications or preparations by Nursing • Back up plan when computer access not available. • Fax back generic/brand name of medications to reduce errors by nursing
Next Steps Go Live ! • Continue Review of Process • Improvements will be ongoing • Quarterly Quality reports • Pharmacy and Administration
Summary -How to Develop a Service • Medical / Nursing Staff and Administrative Support • Market and Coordinate with Hospitals • Develop Contract between sites • State Board of Pharmacy Approval (2-4 Months) • Implementation • Training at Site, • On Site review of Process Introduction to staff • Formulary Review Understand your Business • Computer Access • Estimated costs $2500- $5000 per site • Video Access ?
More Questions? • Bruce Thompson, MS,RPh Fairview Northland bthomps4@fairview.org 763-389-6625
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