Oncology Rounds

How your pharmacist can be in six places at once

by Kenna Hawes

Telehealth has tremendous potential to improve patient access, and as a result, improve patient outcomes. Yet to date, the applications in cancer care have been limited.

Yale New Haven’s Smilow Cancer Center recently developed a telepharmacy program, which has succeeded in reducing medication turnaround times, increasing patient safety, and making more efficient use of pharmacists’ time.

Telemedicine extends pharmacist supervision virtually

Smilow developed its telepharmacy program to extend pharmacists' expertise across multiple sites without compromising efficiency of chemotherapy mixing at those sites.

Pharmacists at any site can log in to the network’s medication therapy queue. The pharmacist, using an audio feed and overhead camera, can monitor and talk with a pharmacy technician as he or she compounds a chemotherapy solution. The system even allows the pharmacist to verify the product through barcode technology and digital photographs taken by the technician throughout the process. After verification, the pharmacist releases the order for administration, as usual.

Benefits: More efficient use of pharmacists, increased patient safety, reduced turnaround times

Telepharmacy capabilities enable pharmacists to supervise multiple locations, which can be helpful for managing variable demand across sites. Telepharmacy can also facilitate coverage from afar when a pharmacist is out sick or on vacation, and it can extend pharmacist services to remote locations, improving access for rural populations. And by providing a central team of pharmacists who are available to supervise technicians’ work, the telepharmacy program enables individual pharmacists to spend more of their time consulting with patients and clinicians.

The telemedicine program has also improved patient safety. Smilow saw a significant increase in error reporting by staff, and a 1.7% reduction in the number of reported patient errors overall. In addition, the program has enabled Smilow to exceed its target one-hour medication turnaround time. Under the telemedicine program, Smilow has seen a 20-minute reduction in average chemotherapy verification and compounding time.

Legal complications

As with any telehealth initiative, organizations interested in pursuing telepharmacy should be sure to research their state’s scope of practice laws.

At the time that Smilow sought to establish its telepharmacy program, it was not legal for a pharmacy tech to complete a chemotherapy order without the physical supervision of a pharmacist in the state of Connecticut. However, after Smilow completed a study demonstrating the safety of remote supervision, the state legislature approved a statute authorizing every hospital in the state to use telepharmacy.

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