There is a large scale national focus on providing telehealth services to areas underserved by various medical specialties.  

Telehealth services are designed to enhance access to care, reduce overall costs of care, and improve the chances for patient outcomes. One area of telehealth, with limited publicity but significant patient safety benefit, is telepharmacy services, which involves providing remote medication order entry and verification services as well as pharmaceutical care services in rural hospitals.

According to the results of a Harvard Medical Practice Study in 1991 that were published in the New England Journal of Medicine, medication errors are common and can result in serious harm to a patient without intervention practices.  A 1997 study in the Journal of the American Medical Association showed a medication error rate of almost four errors per 1,000 medication orders, mostly at the time of writing the medication order.
The number may seem small, but the impact can have disastrous consequences, including the potential for death.  The takeaway from these early studies brought about significant changes in the medication use process.  Specifically, practices were instituted to require pharmacist review of medication orders before the medications were administered to patients.

Hospital pharmacy isn’t quite the same as the traditional retail pharmacy setting. Although there are similarities of general medication review, patient care needs in the hospital setting require additional attention and services.
Patients in the acute-care hospital setting are typically very sick, and the hospitals deal with medications having a greater propensity to do harm if not dosed and administered correctly.  Pharmacist oversight in this case is crucial to optimal patient outcomes. In the hospital setting, pharmacists are called upon to provide a high level of clinical expertise with regard to medication selection, preparation, and administration.

Telepharmacy services are a significant factor in reducing medication errors in rural hospitals. Rural areas often are served by “critical-access” hospitals, a designation established under the 1997 Balanced Budget Act to help rural hospitals maintain financial viability and proximity to rural patients. Nationally, there are more than 1,300 critical-access hospitals. Such facilities typically are operated by a public hospital district and supported by federal, state, and local funding.  

This rural-hospital program maintains general health care services within reach of a patient’s home and reduces the need for extensive travel to urban centers. A general deficiency of this health care system is access to medical specialties and full-time local staffing of nurses, physical therapy, laboratory technicians, and pharmacists. Compounding this situation has been a reduced availability of pharmacists in general.    

Many critical-access hospitals have limited or no pharmacists providing routine 24-hour review of medication orders.  

The generally accepted practice of medication use, in the hospital setting, is as follows: A physician writes a medication order. A drug-utilization review is performed by a clinical pharmacist. The medication is pulled from an automated drug-dispensing unit at a nurses’ station. The nurse performs a review, and medication is administered to the patient. All of these checks and balances set up through pharmacy services provide a high level of patient medication safety.  

Remote medication order review is made possible with technology. By using a secure, high-speed Internet connection, a pharmacist has the same access to information that  he or she would if sitting in the hospital pharmacy reviewing the same medication orders in person.

Remotely, the review can be done by a hospital pharmacy department in a larger urban center, a regional or national telepharmacy provider, or an individual on-call employee pharmacist working remotely from home. All of those methods have been shown to provide enhanced patient safety and a significant reduction in the potential for medication errors, even though a pharmacist isn’t physically at the hospital.  

At Medication Review Inc., we have a pharmacist intervention rate of about 8 percent. Of that 8 percent, about 10 percent of those have the ability to do significant patient harm.

The other benefit, is that rural hospitals, with 24-hour pharmacist medication order review, have the same level of patient care that they would receive if they were in an urban center hospital.  A reduction of medication errors or adverse drug events provides both implicit and explicit cost savings to both patients and hospitals.

Specifically, a pharmacist’s review of drug utilization evaluates medication orders for appropriateness of the medication to the purpose intended, verifying that the dose is appropriate to the age, liver, and kidney function of the patient. The review also confirms that the prescribed method for administering the drug is the most effective for the purpose intended and that the patient hasn’t exhibited allergies to the ordered medication or other like medications in its class. The process also verifies that there is no significant drug interaction or therapeutic duplication within all of the medications prescribed.

Telepharmacy services also provide needed support for physicians, other licensed providers, and nursing staff.  Physicians access telepharmacy services for needed drug information, clinical guidelines consults, formulary reviews, and dosing guidelines for which clinical pharmacists are specifically trained. Nursing staff rely on the telepharmacy functions as a safety net for medication administration and IV compatibility.

Telepharmacy is the most rapidly growing service in the pharmacy field, and the benefits are quickly being realized.  Two recent articles published separately in the American Journal of Health System Pharmacy, conclusively show that telepharmacy services decrease the number of potential adverse drug events in facilities with limited or no pharmacist services.

K. Douglas Crafton is president and CEO of Medication Review Inc., a Spokane-based telepharmacy company.