E-Pharmacists Improve Patient Safety, Staff Efficiency

By Stacy Lawrence  |  Posted 04-06-2005

Subscribing to an online service lets hospitals have a pharmacist on hand 24-by-7, even when there's not one on-site.

Nearly 4,000 hospitals in the United States don't have around-the-clock pharmacy services, due largely to a persistent shortage of pharmacists that's expected to continue to worsen over the next several decades.

Union Hospital in Elkton, Md., is one of many hospitals that does not have a pharmacist available on-site after 9 p.m., despite the need for newly prescribed drugs to be dispensed throughout the night. Union's solution was to subscribe to Rxe-source, a service from Cardinal Health that makes pharmacists available throughout the night.

Traditionally at Union and other hospitals without a 24-by-7 pharmacy staff, if a pharmacist is unavailable during the night shift of a hospital, a nurse takes the medication order from a physician and, in order to access it immediately, presents the request to the house supervisor, who then overrides the need for pharmacist approval and provides access to the medicine.

Orders are then reviewed and input into the system in the morning by the staff pharmacist. Often, if the need for the drug was immediate, it has already been administered to the patient. Only then is there the potential to catch problems including drug interactions or patient allergies.

Instead of this patchwork solution, Rxe-source connects hospital staff to a pharmacist at Cardinal Health's off-site pharmacy service center, where the pharmacist is able to immediately review the medication orders and patient records, verify the accuracy of the order and enter it into the hospital system. This allows the nurse to administer the approved medication.

In addition to improved patient safety, Union Hospital pharmacy director Kathy Tierno said it's helped to ease the burden on pharmacists. "The pharmacist isn't as stressed out; they don't look forward to this big stack of orders. Instead they can start their workday."

Overall, Union Hospital is satisfied with the implementation of Rxe-source. Cardinal Health worked with the hospital in advance of the rollout to understand its policies and procedures. But still, Tierno said, "every hospital has its own idiosyncratic procedures around the pharmacy. There were a few kinks in the beginning and every now and then there have been a few kinks."

But the staff has quickly acclimated, she said. "At times they are kind of spoiled. They are sending in orders that they want immediately for non-immediate drugs. They have to realize that Cardinal is servicing not only our hospitals but others as well."

Secure Internet access and advanced automated systems allow Rxe-source pharmacists to review, enter and authorize orders directly into the hospital system. Reporting capabilities allow the system to continually quantify the savings the service brings to hospitals by tracking clinical interventions and other key productivity metrics.

Cardinal Health already has 90 hospital customers for Rxe-source and an additional 30 are currently evaluating the service. It's approved by state pharmacy boards in 48 states. The remainder of the states have relatively few hospitals, according to Cardinal Health.

"We're on a pace to process about 3 million orders annually through our center," said Ron Graham, general manager of Cardinal Health's pharmacy resources business. "We've done over 50,000 clinical interventions on therapy including on drug-drug interaction, wrong dose and patient allergy. Of those, 14,000 have been what we would classify as significant patient safety issues."

Not only can patient health be improved, but electronic access to a pharmacist is also helping with the productivity of hospital staff. Since the orders are processed at night, rather than just waiting for a pharmacist in the morning, Graham estimates that Rxe-source improves productivity by 20 percent or 30 percent for in-hospital pharmacies. For house supervisors, who previously spent 70 percent to 80 percent of their time dealing with drug-related issues, electronic pharmacist access can cut that down dramatically to less than 20 percent, according to Cardinal Health figures.