February 2010

ePharmacist Direct Improves Safety for Rural Patients

By providing rural hospitals with 24-hour access to licensed clinical pharmacists, CHI's ePharmacist Direct program helps ensure safety for hundreds of patients each day through medication verification, order entry and clinical intervention services.

At 5 a.m. on Christmas Day 2009, ePharmacist Direct's Christy Martin was on duty and reviewed an order for a dose of antibiotics for a six-day-old infant in a hospital hundreds of miles away. Martin double-checked the dose, advised the nurse who sent the order that it was too high and provided a safe dosage amount. "Later, the hospital's pharmacist called to thank us," said Shelley Johnsen, director of the ePharmacist Direct program. "If the baby had received the original dose, it could have resulted in permanent hearing or kidney damage."

Not every review conducted by ePharmacist Direct has such dramatic results, but they all ensure greater safety for patients at rural facilities that don't always have a pharmacist on site to perform medication reconciliation or clinical intervention. The program's central site is in Fargo, ND, where Johnsen and a staff of clinical pharmacists provide 24-hour coverage to 10 CHI and non-CHI hospitals in North Dakota and Minnesota. The program is set to add five more Minnesota hospitals in the coming weeks.

Each connected hospital communicates with the central site in real time, via camera and computer. Nurses or pharmacy technicians send medication orders to ePharmacist Direct electronically. A pharmacist reviews and verifies each order and consults with the nurse, technician, physician or patient as needed. The nurse or technician obtains the medication from the hospital supply, then prepares or verifies it under the direct visual supervision of the ePharmacist Direct pharmacist.

Hospitals that use the ePharmacist Direct service have been able to improve the overall percentage of medication doses administered with pharmacist review and approval. For example, one hospital previously administered 20 to 30 percent of medication doses without pharmacist review. "When the hospital signed on for 10 hours of service daily from ePharmacist Direct, that percentage immediately dropped to just over eight percent," said Johnsen. "When the hospital changed to full-night coverage plus 24-hour coverage on weekends and holidays, the percentage dropped to 1.6 percent, which are primarily emergency cases."

Johnsen looks forward to expanding the ePharmacist Direct service to cover more CHI hospitals, as well as other acute care providers. "Every time a clinical pharmacist reviews a medication order, the patient becomes a safer patient," she said. "We're here to provide that assistance to hospitals that don't have a pharmacist on site 24 hours a day." For more information, contact Shelley Johnsen at shelleyjohnsen@catholichealth.net.

Note: The project described here was supported by a grant from the NDSU College of Pharmacy, Nursing, and Allied Sciences and the North Dakota Telepharmacy Project with funding from the Office of Health Information Technology/HSRA/DHHS