Nurses and pharmacists collaborate closely for the benefit of their patients. When pharmacy staffing issues, such as medication order volume spikes due to increased census or when a pharmacist calls out of work, arise they can have a significant impact on nursing workflow. Without appropriate pharmacy staffing, backlogs, miscommunication and potential medication variances can occur.
Pharmacy is responsible for making sure medication orders are reviewed in a timely and accurate manner. When these clinical resources are unavailable or short-staffed, it puts strain on nursing, and can lead to frustration and dissatisfaction among nursing staff. Nursing workplace satisfaction influences patient satisfaction, and can affect HCAHPS ratings, which impact reimbursement for hospitals. However, staffing up to meet peak demand or to cover unexpected shortages can also be cost prohibitive.
Telemedicine and Telepharmacy Adoption in Hospitals
To navigate these unpredictable scenarios, hospitals are increasingly turning to telehealth solutions as a cost-effective approach to only address staffing issues and improve the quality of patient care. A recent study revealed that telemedicine solutions are on the rise, with 45% of US hospitals using telemedicine technologies today, projected to reach over 50% by 2020.1
Telepharmacy, an extension of telemedicine, provides supplemental clinical pharmacy expertise to hospitals and other healthcare facilities from a remote location. These highly experienced clinical pharmacists can review and verify orders remotely through an integrated technology platform, and e-consult with on-site providers via phone or video. This approach offers a wide range of benefits for hospitals, from seamless coverage during staffing shortages to improved workflows, often at a significantly lower cost than by increasing on-site pharmacist staffing.
How Telepharmacists Provide Additional Support for Nurses
All nurses have been trained on the 'five Rs' (right patient, right drug, right dose, right route and right time) since their first week of nursing school, and understand the need to follow these golden rules. However, nurses rely on pharmacists' clinical expertise to review medication orders and perform safety checks, including drug interactions, patient allergies, and clarification related to doses or administration times. Telepharmacy offers additional flexibility, staffing, and clinical support to hospitals, and helps the nursing department in three key ways.
1. Extending pharmacy coverage
At rural hospitals with restricted in-house pharmacist availability, or at busy healthcare facilities during peak hours, pharmacy staffing has a critical impact on nursing, specifically as it relates to medication order review, verification and administration. If pharmacists aren't available, nurses often pick up their roles, balancing these medication decisions with their regular patient care and administrative responsibilities, adding unwanted liability for the medication order.
While nurses are already stretched thin managing multiple patients, this new responsibility adds additional time and increased pressure to a frenetic schedule. With telepharmacy support available, organizations can ensure sufficient pharmacist coverage, so that nurses can focus on their primary patient care responsibilities with less disruption to their workflow.
2. Improving medication administration
Since the nurse is ultimately responsible - and accountable - for the appropriate administration of medications, timely review of medication orders is critical. Employing telepharmacists can help facilitate faster turnaround times during peak hours or after hours when the on-site Pharmacy is closed, so that medications are reviewed, verified and available when required. This is particularly critical during overnight shifts when a patient is released from surgery and moved to the post-operative unit and may need pain medication. The STAT med order must be reviewed and approved within minutes, otherwise the patient may suffer unnecessarily, and HCAHPS scores may be negatively impacted, decreasing hospital reimbursements as a result.
3. Enhancing clinical support
Nurses and pharmacists form a critical link in patient care. Nurses rely on the clinical expertise of trained pharmacists to help ensure the five rights. One such interaction is during medication reconciliation for a newly admitted patient, when a nurse calls the pharmacist to identify medications brought in by the patient. The nurse may also seek confirmation for a dose calculation or inquire about potential side effects to expect with a new medication, or request retiming of a medication after a patient's schedule was interrupted by a test or therapy. With telepharmacy services staffed by experienced clinical pharmacists, the answers and resolution to these types of questions are just a phone call away.
There's no question that engaged nurses are essential to patient care and a hospital's success. As the role of nurses in influencing hospital reimbursements continues to grow, telepharmacy can be a strong pillar of support for these providers, helping them to deliver the best care possible. For hospitals, nursing, and pharmacy leaders looking to equalize staffing levels and support the nurses at their facilities, telepharmacy offers a flexible, accountable, and cost effective solution that's already proving itself out in hundreds of facilities across the country.
1. FitzGerald, Brendan. "Telemedicine Adoption Continues Growth in 2016 and Beyond." HIMSS Analytics. April 27, 2016. http://www.himssanalytics.org/news/telemedicine-adoption-growing-35-annually-2014
Chris Ciolko, is senior vice president of business development and co-founder of PipelineRx. She has spent her entire career focused on pharmacy services and increasing the efficiency of healthcare service delivery, including positions with companies such as RPh-on-the-Go, Cardinal Health, V. Mueller, MedManagement, Baxter Healthcare, and Eli Lilly.