COLUMBIA, MO – The implementation of a telepharmacy model in a multi-hospital health system increased access to pharmacy services, allowing for round-the-clock medication order review by pharmacists, which is critical to reducing errors, according to a new study published in the American Journal of Health-System Pharmacy.

"Approximately half of all medication errors occur in the prescribing stage of the medication-use process and may be attributed to the prescriber's lack of knowledge of a drug, the prescriber's failure to adhere to accepted practices and procedures, or general slips and memory lapses during the ordering process," wrote the authors. "Pharmacist review of medication orders reduces prescribing errors, as the pharmacist screens the orders for incorrectly prescribed medications (e.g., wrong drug, wrong dose, wrong frequency), interactions, and contraindications."

Effective execution of all aspects of the medication-use process, including prescribing, dispensing, and administration, is necessary to ensure high-quality, safe medication practices, they added. Many regulatory, advisory, and purchasing groups have established numerous requirements and recommendations for improving medication safety. Chief among these is the need for pharmacist review of medication orders before medications are dispensed and administered to patients.

The process
Seven critical access hospitals (CAHs) worked collaboratively as part of a network of hospitals implementing the same electronic health record, CPOE system and pharmacy information system to serve as the health information technology backbone supporting round-the-clock medication order review by pharmacists.

Collaboration permitted standardization of workflow policies and procedures. Through the health IT backbone, both onsite and remote pharmacists were given access to the medication orders, the pharmacy information system, and other patient-specific clinical data in patients' EHRs.

Orders are typically reviewed within 60 minutes of when they are entered into the system. The reviewing pharmacists have remote access to the EHRs in each CAH.
 
After completing the clinical review, the pharmacist selects the appropriate medication to dispense from the CAH's formulary. If the medication order is not made using the CPOE system, the order is scanned into a document and sent via e-mail to remote pharmacists.

The pharmacist enters the necessary information into the EHR and pharmacy information system. The medication order review process from this point forward is identical to that used for medications ordered via CPOE. The new medication order is then entered into the EHR, and the CAH nurse can proceed with the order.

The study's authors are: Douglas S. Wakefield, professor Department of Health Management and Informatics, the University of Missouri Informatics Institute, and Director, Center for Health Care Quality, University of Missouri, Columbia; Marcia M. Ward, professor and associate head, Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City; Jean L. Loes, network clinical information analyst, clinical practice and informatics, Mercy Medical Center, North Iowa, Mason City; John O'Brien, CEO, Ellsworth Municipal Hospital, Iowa Falls, Iowa; and Leevon Sperry, graduate research assistant, Center for Health Care Quality, University of Missouri.