Remote 24 hour Pharmacy Service From 40 Feet to 40 Miles 200 Miles Bruce Thompson, MS,RPh Fa

1. Remote 24 hour Pharmacy Service From 40 Feet to 40 Miles 200 MilesBruce Thompson, MS,RPh Fairview Northland

2. Faculty Disclosure - Faculty has nothing to disclose.

3. Fairview Care Systems Northland Lakes Southdale University Ridges Range - Hibbing Red Wing 22

4. Northland Medical Center

5. 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. .

6. 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."

7. 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.

8. 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

9. 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

10. 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

13. 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

14. 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.

18. 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.

19. 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.

20. 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

21. 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.

22. 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.

23. 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

24. 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

25. 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

26. 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

27. 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

28. 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

29. Next Steps Go Live ! • Continue Review of Process • Improvements will be ongoing • Quarterly Quality reports • Pharmacy and Administration

30. 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 ?

31. More Questions? • Bruce Thompson, MS,RPh Fairview Northland bthomps4@fairview.org 763-389-6625

32. You spend a fair amount of time at work.. Let’s make it enjoyable.