Telepharmacists Keep a Small Hospital Pharmacy Running After Hours

March 28, 2019 - Situated in the countryside of south central Wisconsin between Janesville and Madison, the City of Edgerton is home to about 5,500 individuals who rely on an 18-bed critical access hospital for many of their healthcare needs, including hospital pharmacy services.

Edgerton Hospital runs a lean hospital pharmacy. The pharmacy is open 8:00 am to 4:30 pm Monday through Friday and 8:00 am to noon on weekends and holidays. Providers at the hospital rely on an on-call pharmacist when the hospital pharmacy is closed.

But when the critical access hospital became affiliated with a larger local medical group and implemented the group’s EHR system, the hospital pharmacy found it needed more support.

“We are affiliated with a larger medical group and because of this affiliation we have access to an EMR that we wouldn't be able to access on our own,” Todd Crowley, Pharmacy Director at Edgerton Hospital & Health Services, recently told RevCycleIntelligence.com. “We are on the Epic system and it is a 24-hour facility-wide program that we're using. Part of the issue is that, being on the Epic system, we need to have pharmacist verification of orders 24 hours a day.”

Living in a small city in the countryside, however, did not lend itself to 24/7 pharmacy verification.

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“We started out with different people or different groups helping us with the after-hour verifications because we don't have the man power to have somebody available even on-call,” Crowley explained. “Having someone always on-call is also extremely inefficient because you never know when orders come in or how many orders there will be.”

Shifting from paper-based to technology-driven medicine has transformed care delivery. EHR systems, computerized provider order entry (CPOE) tools, and other technologies are allowing providers to comprehensively treat patients in real time, and patients are accessing more services as result.

However, health IT implementation can come with unintended consequences, especially at small, rural hospitals.

Hospitals need the appropriate number of staff available to deliver real-time, comprehensive care, but geographic isolation and small population numbers can challenge health IT efficiencies. Hospital executives also may not be able to justify additional labor spending, which can already account for up to 60 percent of a hospital’s budget, when patient volume is so low.

Like many other critical access hospitals, having a staff member in the pharmacy or on-call 24 hours a day wasn’t an option for Edgerton Hospital despite the gap in pharmacy care impacting providers and patients.

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“From the very beginning we needed to find some way of having these orders verified after hours,” Crowley said.

Expanding the pool of qualified pharmacists through telepharmacy ended up being a solution for Edgerton Hospital. The critical access hospital partnered with PipelineRx to get providers 24/7 access to qualified pharmacists who could verify orders and help care delivery run smoothly at all times.

“We get a telephone call when the telepharmacists are scheduled to start taking over and we walk out the door. Then, we come back in in the morning and we get a notice from the telepharmacists letting us know if there were any issues that they had over the evening, if they have to hand off orders, or if there were items to be aware of. It's a very seamless system,” Crowley stated.

The telepharmacists also function as another arm for the hospital pharmacy, following hospital-specific protocol to ensure seamless care delivery.

“We give them information about the way we would like them to address something. They keep that in mind,” Crowley explained. “We have guidelines and policies, as well as our formulary. We have a list of substitutions that the facility has agreed on, so if a physician orders one product and it is not on our formulary, we'll automatically substitute a different product.”

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“We also give out instructions that are not necessarily in a protocol or a policy,” he added. “For example, we have unwritten policies for when a physician writes an order and doesn’t put the first dose time. We've asked Pipeline to be aware of that first dose and recognize if we really want to start giving that Colace at 11:30 at night when the next dose is due at 8:00 in the morning. We've told also Pipeline that their pharmacists can use their judgment in those cases and determine when it is clinically necessary to start immediately.”

Telepharmacy solved Edgerton Hospital’s after-hours pharmacy service problem, Crowley emphasized. And the solution did so by providing financial stability and security for the critical access hospital.

“Being a small institution, some telepharmacy programs we looked at had a fairly high monthly fee and programs were looking at a certain cost-per-order for volumes that we could never reach,” he said. “We have so few orders that needed verification that our ultimate cost-per-order-verified was quite large.”

Crowley went with a telepharmacy solution that recognized the financial challenges associated with being a critical access hospital.

“We're paying a flat fee for an average number of prescriptions or orders verified. And if we go above that number, then there's an additional charge involved,” he elaborated. “We haven't gotten to that extra charge, so our base price is still very reasonable compared to some of the other services that I've looked at.”

“Financially, we are more stable. We can now predict from month to month what the charges will be for orders.”

Health IT implementation can be a double-edged sword for critical access hospitals. But advancements in healthcare technology are also presenting solutions to hospitals in unique positions, including connecting a small, country hospital to qualified pharmacists across the country to cover after-hours services.