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Dartmouth-Hitchcock Telepharmacy

Dartmouth-Hitchcock Telepharmacy. Advancing Clinical Pharmacy through Telepharmacy. Matthew J. Maughan, PharmD. We are an Academic Health System. 6 campuses. 29 clinical locations. 20 affiliate and alliance hospitals. Serving a population of 2 million.

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Dartmouth-Hitchcock Telepharmacy

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  1. Dartmouth-Hitchcock Telepharmacy Advancing Clinical Pharmacy through Telepharmacy Matthew J. Maughan, PharmD

  2. We are an Academic Health System 6 campuses 29 clinical locations 20 affiliate and alliance hospitals Serving a population of 2 million

  3. Serving a Broad and Rural Region • 396 Licensed Beds • NCI Comprehensive Cancer Center • Level 1 Trauma Center • Comprehensive Full-Service Children’s Hospital (CHaD) • MICU, SICU, Neonatal ICU, Pediatric ICU • Helicopter and Critical Care Ground Transport Service (DHART)

  4. Current Telemedicine Services D-H Connected Care Emergency Specialty Urgent Care Pharmacy ICU Neurology Psychiatry

  5. Telepharmacy Services • 18 total hospitals • 2 Health Systems • 5 locations • 4 locations • Over 50,000 orders reviewed each month

  6. Goals of Clinical Pharmacy • Prospective review of 100% medication related activity • Prioritizing patients with biggest impact

  7. Principles of Clinical Pharmacy American Society of Health-System Pharmacy Statements1 • Pharmacist’s Role in: • Antimicrobial stewardship and infection prevention and control • Clinical pharmacogenomics • Primary care • Medication reconciliation • Public health • Age specific competencies; Pediatric or Geriatric • Pharmacy services to the Emergency Department

  8. Principles of Clinical Pharmacy What are the barriers? • Costs of a pharmacist vs expected return • Availability of pharmacists with expertise

  9. Telepharmacy Services • Value proposition is simple • Lower costs of pharmacist services • Onsite pharmacist perform tasks only they can do • Access to antimicrobial stewardship • Assistance with Medication Reconciliation

  10. Principles of Telepharmacy • Create more efficiency • Consolidate expertise • View the system as a whole

  11. Principles of Telepharmacy Procure Monitor Store Document Prescribe Administer Order Review Prepare & Dispense

  12. Principles of Telepharmacy Procure Monitor Store Document Prescribe Administer Order Review Prepare & Dispense

  13. Principles of Telepharmacy Procure Monitor Store Document Prescribe Administer Order Review Prepare & Dispense

  14. Telepharmacy Services: Example 1 • Community Hospital • Rural community with recruitment issues • Pressure to save on expenses • Clinical needs that were unmet

  15. Telepharmacy Services: Example 1 • Traditional overnight shift 10pm – 8am • Weekend evening coverage • Solves the recruitment problem • Savings on the shift

  16. TelepharmacyServices: Hospital 1 56% $ 51% 47% 45% 51% 44% 46% 42% 43% 41% 41% 40%

  17. TelepharmacyServices: Hospital 1 $ 54% Savings

  18. Telepharmacy Services: Hospital 1 • 2 Pharmacists on leave • Fathers who were sick or died • Previously granted vacation

  19. TelepharmacyServices: Hospital 1 $

  20. TelepharmacyServices: Hospital 1 Onsite Pharmacists had capacity to do orders $

  21. TelepharmacyServices: Hospital 1 More Pharmacists out which diverted more volume to telepharmacy $

  22. TelepharmacyServices: Hospital 1 • Continued clinical rounding with medical teams • Maintained medication reconciliation activities for every admission $

  23. Telepharmacy Services: Example 2 • 24hr coverage from the beginning of service • Antimicrobial stewardship • Clinical rounding

  24. TelepharmacyServices: Hospital 2 $

  25. TelepharmacyServices: Hospital 2 $

  26. Telepharmacy Services: Hospital 3 • Staff that needed leave for medical reasons • Maintained clinical services • Post Acute Care Unit • Same Day Surgery

  27. TelepharmacyServices: Hospital 3 $ 52% Savings

  28. Telepharmacy Services: Hospital 3 • After hour coverage • ER Coverage

  29. TelepharmacyServices: Hospital 3 52% Savings

  30. TelepharmacyServices: Hospital 3 Started work with Emergency

  31. Conclusions • Clinical pharmacy activities provide tremendous value to patient outcomes • Telepharmacy provides a cost effective solution to increasing clinical pharmacy • Telepharmacy is versatile tool to assist with staffing needs

  32. References • https://www.ashp.org/Pharmacy-Practice/Policy-Positions-and-Guidelines/Browse-by-Topic/Medication-Therapy-and-Patient-Care

  33. Telepharmacy Services Update • 5 initial partner hospitals • Contract renegotiated to reduce price to partners • Now 18 total hospitals • 2 Health Systems • 5 locations • 4 locations • Over 50,000 orders reviewed each month

  34. Telepharmacy ServicesUpdate Patient Safety Cost Savings • Nearly 700 patient safety interventions • 33% Clinical pharmacy activities like dosing adjustments to medications • 33% Errors in medication order that could have resulted in patient harm

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