Pharmacists are taking on a much larger role than ever before in hospitals' strategic initiatives.
"Historically, pharmacists’ focus was predominantly within the 4 walls of the pharmacy.” says Kelly Morrison, director of remote and retail pharmacy services for Dublin, Ohio-based Cardinal Health. "Their role didn’t involve getting out on the floors working directly with care teams and interacting with patients. That's changed now."
As onsite pharmacists take on more initiatives, such as medication reconciliation and discharge patient counseling, the hospital loses valuable labor resources to perform medication order entry and reviews. In these circumstances, remote pharmacy models can be leveraged to offer a convenient and flexible method to supplement onsite pharmacists, according to Ms. Morrison.
She spoke with Becker's Hospital Review about the benefits of remote pharmacy models and shared how hospitals can expand services by maximizing labor while minimizing costs.
Editor's note: Responses have been lightly edited for style and clarity.
Question: How are remote pharmacy models expanding pharmacy's role and reach?
Kelly Morrison: Within the last three to four years, pharmacies have been asked to get involved in many more initiatives that broaden their role, due in part to healthcare reform. For example, both the adoption of computerized physician order entry and initiatives to reduce 30-day readmissions are impacting pharmacy resources. With the adoption of CPOE, the medication order entry volume typically increases due to pharmacy having to review orders for areas they did not prior to CPOE; such as the emergency department and other procedural areas. In addition, one of the most effective methods to reduce 30-day readmission rates is through patient discharge counseling driving medication adherence post-discharge. In addition, hospitals are challenged executing medication reconciliation programs that are most effective when pharmacy is involved.
With pharmacists serving many more roles than in the past, hospitals are forced to re-allocate pharmacy resources. Hospitals could hire more pharmacists, however most are trying to maximize labor since healthcare reimbursements and budgets are flat. Using remote pharmacists can often achieve cost savings for hospitals and allow onsite pharmacists to focus on other initiatives. With remote pharmacies, hospitals don't have to deal with recruiting, human resource issues, pharmacists taking vacation time or sick leave, etc. This enables hospitals to provide a consistent level of care 24 hours a day, 365 days a year.
Q: How are other health systems managing labor to support pharmacy-led initiatives?
KM: Many health systems are using remote pharmacy models to supplement their onsite team to expand hospital-based pharmacies' staff. One health system in North Carolina employs a pharmacy staff to support their 24-hour pharmacy operation. In the past the pharmacy didn't have a need to supplement their staff with remote pharmacists. However, in the last year a key initiative for them was to reduce their 30-day readmission rates, so they did a pilot where they allocated a pharmacist to counsel patients about their medications prior to discharge in some critical care areas. This approach yielded a positive impact in reducing their readmission rates, therefore, they wanted to expand it throughout the hospital. Yet to do that, they had to reallocate pharmacist time to support this initiative and are leveraging remote pharmacy model to supplement the on-site staff to ensure on-going medication order entry continued to be performed timely.
In some cases, hospitals need a labor solution to address a specific project for a short period of time. Another health system has a centralized remote pharmacy service in place internally, however, the health system temporarily engaged Cardinal Health for remote pharmacy services to help with a technology implementation and a medication reconciliation project that would be a strain on their resources for several months. Rather than hire new staff for a short period of time, they decided to leverage Cardinal Health’s remote pharmacy service to supplement their own.
Q: How can a remote pharmacy model be leveraged to support a retail strategy?
KM: Many retail pharmacies are challenged managing higher patient volumes while expanding services to under-served, remote communities. Leveraging remote pharmacy models can help these pharmacies ensure the scripts are processed and filled timely to enable medication adherence.
Providing pharmacist support to a small population can create financial challenges. However, several new technologies enable pharmacists to expand their reach remotely, depending on each state’s regulations.
In addition, health systems often have an ambulatory care network throughout the community, and want to be able to expand pharmacy services to these sites. Using a remote pharmacy model is often a cost effective approach that improves patient safety and outcomes.
Q: How do you see remote services evolving hospital care in the next five to 10 years?
KM: In the next five to 10 years, more and more healthcare will be conducted outside the four walls of the hospital in ambulatory care sites, infusion centers, urgent care facilities and outpatient surgery centers. Employing on-site pharmacists in these environments can be cost prohibitive, therefore expanding remote pharmacy models to service patients and providers outside of the hospital will be critical.
But it’s not just about pharmacy. Telehealth initiatives and regulations continue to address the expansion of many remote clinical services and will become more common in the future.
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