24/7/365 in-house pharmacist coverage can result in a scheduling nightmare and high expense for hospitals. Telepharmacy offers another way to go.
The challenge of 24/7 pharmacy coverage, which includes nighttime hours, weekends, and of course, holidays, confronts large and small hospitals alike, and for both can be a scheduling nightmare.
In 2011, a small rural community hospital took the bold step of staffing its pharmacy from 9:00 p.m. to 7:00 a.m. with a remote telepharmacy solution provided by PipelineRx. This business approach, modeled after other telemedicine solutions such as teleradiology, uses home-based pharmacists working in a HIPAA-secure environment to verify and approve computerized provider order entry (CPOE) orders, which they obtain through the electronic medical record (EMR) by means of a virtual private network.
Scott BurnsFour years later, Scott Burns, director of pharmacy at Rome Memorial Hospital, Rome, N.Y., believes the decision was the right one for this 130-bed facility. The greatest benefits, he said, have included being able to ensure that the EMR is accurate at all times, saving money through use of an outsourced pharmacy model, and keeping a consistent pharmacy staff that physicians and nurses are comfortable with.
If your health system is considering a remote staffing model like PipelineRx, one of the most important tasks is to make sure that your policies and procedures manual is up to date and ready for you to share with the remote pharmacists.
Burns explained that every community hospital operates differently, so it is important that the telepharmacy staff have a clear understanding of expectations. Be sure to review your policies and procedures carefully and make any necessary updates in your manual. This will ensure that the telepharmacy staff is set up for success, he said.
“At the end of the day, my biggest issue [with telepharmacy] was from the medical staff perspective, that there should be very little disconnect. They should not necessarily even know that there was a telepharmacist taking care of their orders, vs. a pharmacist on site,” Burns told Drug Topics.
Brian RobertsFor an average order, turnaround time is about seven minutes. Approximately 5% of the orders require some type of intervention, according to Brian Roberts, CEO of PipelineRx.
“We have noted over 20 types of interventions the [PipelineRx telepharmacists] do, such as with drug-drug interactions, drug allergy, or dosing changes. Also included are switching from a brand drug to a generic and moving an expensive IV drug to an oral drug. This brings value back to the hospital in terms of safety and cost savings,” Roberts said. “Without interruptions like a question from a nurse or the phone ringing, the telepharmacists can more quickly verify orders [than the in-house pharmacists can].”
Use of an outsourced telepharmacy model results in substantial cost savings, Burns noted. In-house, night and holiday coverage of his facility’s pharmacy would have required two full-time equivalent (FTE) pharmacists and two FTE technicians. Besides the salaries and benefits, each pharmacist starts with five weeks of paid time off - which then would require the six regular daytime pharmacists to cover one to two night-shift weeks throughout the year.
“My estimation is that we save about 45%, compared to staffing completely full-time in-house,” Burns said. “So beyond the fiscal savings, there was a scheduling benefit for covering nights and vacation requests. We preserve our sanity, which has a value too.”
Burns also commented that he is especially pleased with the team of PipelineRx pharmacists - which has remained consistent over the course of the past four years. He considers them part of the Rome Memorial Hospital team.
“We have a nice rapport with our PipelineRx team as we do check-ins and checkouts at the beginning and end of each shift,” Burns said. “We have gotten to the point the we know each other a little more personally, as well as professionally. It helps with the expectations when you have a core group to deal with.”
For large integrated delivery networks (IDNs) that want to use their own in-house pharmacists for day and night coverage, PipelineRx offers its telepharmacy information systems software platform, Roberts said.
“Rather than staffing 85 pharmacists on night work, the IDNs can build their own telepharmacy from the inside, with a fraction of the staff. The cost savings are dramatic - in the 40% range for hospitals’ operations,” he said.