Care Across Distance

The Benefits & Potential Drawbacks of Telepharmacy Services

When telepharmacy programs began in the early 2000s, the idea was simple: enable pharmacists to review prescription orders remotely. A physician prescribed a medication based on a patient’s needs and sent off orders to be reviewed by a pharmacist before a nurse administered the medication. In rural communities, this service allowed hospitals without 24-hour pharmacies to verify prescriptions at all hours. Even after the hospital or pharmacy closed for the night, a pharmacist—perhaps working several states away—could review orders.

Jason Braithwaite

Today the scope of telepharmacy has expanded to include a range of remote services, from verification to dispensing to advising. Telepharmacy allows pharmacists to provide specialized care in areas where patients might not otherwise have access to it. But despite all the benefits that have come with the industry’s expansion, there are always opportunities for improvement.

Prior to his role at HealthTrust as senior director of clinical pharmacy services, Jason Braithwaite, PharmD, MS, BCPS, served four years as division director of clinical pharmacy services for a healthcare system with hospitals in Utah, Idaho and Alaska. The system decided to offer telepharmacy services to its hospitals and hired pharmacists to work in a centralized Colorado office. It was here Braithwaite encountered his first obstacle: insufficient training. Many of the pharmacists in the Colorado office came from retail settings and lacked the training to approve orders—like intravenous medications—from hospital physicians.

Today across telepharmacy services, however, “training has absolutely improved,” Braithwaite says. With an informed understanding of telepharmacy’s opportunities and challenges, hospitals are poised to offer the best possible care to their patients—
no matter how remote the setting or how specialized the need.

Benefits

Specialized services. Telepharmacy democratizes healthcare by offering small hospitals the same benefits as larger urban facilities. With remote telepharmacists on call, a small hospital in rural America can still prescribe and verify medication even after the on-site pharmacy closes for the night. By utilizing remote pharmacists during daytime hours, the hospital’s pharmacists are freed to accompany physicians on their rounds and make bedside recommendations. And while a smaller hospital most likely lacks a specialized pharmacist on-site, the practice of telepharmacy provides access to one. “Small hospitals won’t often have an infectious disease pharmacist or one specialized in anticoagulation,” Braithwaite says. “With telepharmacy, hospitals can really start to take advantage of those remote services.”

Personal care. One of hospital pharmacists’ main responsibilities is to approve orders before medication is administered. Yet that’s not always the most efficient use of their time. Instead of remaining in the pharmacy, pharmacists could be accompanying doctors on rounds and optimizing prescriptions while patients are still in the hospital. By outsourcing the medication verification, pharmacists working within the hospital can spend more time with patients in the ICU or ER. For this reason, many hospitals use telepharmacy services during the day as well as night—not to replace pharmacists on staff, but to maximize their on-site work.

Antimicrobial stewardship. According to Braithwaite, telepharmacy is starting to be used in the management of antibiotics. Nationwide, antibiotics are over-prescribed in both inpatient and outpatient settings, leading to antibiotic resistance and susceptibility to infection due to a lack of healthy bacteria. “To produce a good outcome, you need a trained pharmacist who knows antibiotics and infections, and how to match the need for treatment with the need for smart infection control,” he says. With the support of remote pharmacists trained in both, rural hospitals can practice better antimicrobial stewardship.

Job flexibility. No longer do pharmacists have to uproot their lives for a job or move to a rural area. Thanks to the growth of the telepharmacy industry, many pharmacists have the flexibility to provide quality patient care from any location. Though some telepharmacists work in a centralized setting, many work from the comfort of their own home office. The flexibility is often a perk when recruiting pharmacists to lesser-served areas.

Potential Drawbacks

Staff size. Of course, the ability to outsource pharmacy services means that some organizations might reduce staff. To prevent hospitals from using telepharmacy as a means of cutting employment costs, many states address the issue of staff reduction in their pharmacy laws. Though regulations vary, state pharmacy laws increasingly include policies or—in California’s case—specific language about job protection. Hospitals interested in telepharmacy should see it as a means of enhancing their on-site pharmacists’ time in the hospital, rather than eliminating it.

Level of service. Telepharmacy can free up hospital pharmacists to spend more time with physicians and patients, but it can also have the opposite effect. “By over-utilizing the service, you’re going to miss out on pharmacists being part of the discussion with the physician or nurse or whoever they’re working with,” Braithwaite says. “Having someone primarily remote [means] they would miss out on discussions that take place bedside or within hospital walls.”

Appropriate training. As Braithwaite discovered, training pharmacists in skills specific to their work setting is an essential piece of telepharmacy’s success. Retail pharmacists are knowledgeable about different areas than hospital pharmacists; likewise, a pharmacist in a clinic has different skills than one in a hospital. With thorough training, however, pharmacists with a range of experiences can succeed in a remote capacity.

Looking to the Future

One unforeseen benefit of telepharmacy and remote verification services is the improvement in standardization. Because telepharmacists might be working with dozens of hospitals at a time, hospitals have had to standardize how they practice medicine—something that will continue as the industry evolves.

“Anytime you can standardize the way you go about taking care of patients, you reduce variability. It’s the variation that can lead to worse outcomes,” Braithwaite says. “From a technology standpoint, telepharmacy has allowed us to go back and look at how we can mitigate errors that might have occurred previously.”

Despite remaining challenges and pain points, telepharmacy makes services possible that—even 20 years ago—hospitals would have gone without. Thanks to these remote services, patients in rural and underserved areas can now access specialized, 24-hour care. The proliferation of telepharmacy illustrates one more way that technology empowers human connection.

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