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Unable to fill their open pharmacy positions and tightened by budget constraints, many hospitals cannot afford to staff their pharmacies 24 hours a day. But even after pharmacy doors close, physicians continue to write medication orders, and new patients continue to be admitted. The lack of an after-hours pharmacist leaves hospitals more vulnerable to medication errors.
To address this problem, one company is offering health care institutions 24-hour-a-day, seven-day-a-week professional pharmacist call center support, including medication order review and order entry. MedNovations’ PharmaCheck After Hours program focuses on being a drug therapy knowledge resource, not just a traditional drug information program where nurses or physicians call if they have a question, says Kenneth Dandurand, RPh, MS, president of the Greenbelt, MD-based company.
"We can’t wait for the nurse to have a question," he says. "With all of the new drugs being approved by the FDA [Food and Drug Administration] each year, physicians and nurses often don’t know the questions to ask because they are not familiar with the drug."
Dandurand sees two primary problems that hospital pharmacies face: medication errors in the hours that the pharmacists are not working, and the significant shortage of pharmacists and nurses. A telepharmacy program allows those hospitals that have trouble filling pharmacy positions to have a support system so their nurses can feel assured that the medications they give are appropriate, he says.
Hospitals are feeling increased pressure to reduce the incidence of medical errors. First, a 1999 Institute of Medicine report targeted medication error as a key contributor to the thousands of deaths every year from medical mistakes in hospitals. Subsequently, accrediting bodies such as the Joint Commission on Accreditation of Healthcare Organizations have identified pharmacists’ proactive review of medication errors as a prime method for improving medication safety.
"The majority of the errors are being made in the ordering phase," Dandurand says. "Physicians don’t necessarily remember all of the doses that are appropriate."
The PharmaCheck After Hours program gives a hospital off-hours access to a pharmacist with hospital-based, clinical experience. Hospitals can phone in orders, scan them into the computer for the company to see, or fax them. MedNovations also can access hospitals through the Internet or through a virtual private network, such as in a telemedicine model.
"We can access laboratory values, [a list of] the medications a patient is already taking, and the patient’s history of allergies," Dandurand explains. "If the computer allows it, we also can enter the prescription information into the system."
If MedNovations receives a fax, the pharmacists review it and verify it. If they find a problem, they contact the appropriate physician from their list of physicians at the hospital or they contact the on-call physician. The turn-around time from receiving the order to acting on it is what hospitals might expect from an in-house pharmacist, Dandurand says.
If the order is correct, the pharmacists fax back a confirmation. "The nurse knows right away that the drug is okay to give to the patient," he says. This can be especially helpful for nurses who work late shifts, he adds, because they are typically less experienced and are operating during those hours without a safety net.
To help nurses initially learn about working with the PharmaCheck After Hours program, MedNovations has provided an orientation about the service. The company also has provided laminated instructions to each nursing unit on how to use the service and how to contact MedNovations.
And at the end of each service day, PharmaCheck After Hours provides a daily pharmacy shift summary report to the pharmacy, documenting all the orders reviewed on the shift, as well as its current status. The in-house pharmacists then can enter their orders.
MedNovations focuses on checking high-risk medications and new admissions. "That is typically where we are going to see a lot of the problems," Dandurand says. Company pharmacists also are available to answer questions from hospital staff. A nurse, for example, may receive approval from PharmaCheck After Hours to administer two drugs. However, she still might not understand how to administer them. The service is available to answer those questions, he says.
MedNovations works with automated dispensing and helps the clinical staff when they have difficulty locating a medication, too. "We have a list that tells us exactly what is in [a facility’s] automated dispensing," he says. If the list identifies a drug by its brand name, and a nurse knows the drug by its generic name, or vice versa, the company pharmacists can tell the nurse where to find the drug.