Medication error reporting in rural critical access hospitals in the North Dakota Telepharmacy Project.

PURPOSE: Results of a study of medication "quality-related events" (QREs) at critical access hospitals (CAHs) participating in a telepharmacy project are reported. METHODS: Rates and types of medication QREs (i.e., all types of drug therapy problems requiring pharmacist intervention) were evaluated at 17 CAHs receiving telepharmacy services from a central order-entry site in the North Dakota Telepharmacy Project (NDTP). During the 17-month study, remote pharmacists used telepharmacy technology to review medication orders prepared at the CAH sites, identify and address QREs, and code clinical interventions. The collected data were analyzed via chi-square testing. RESULTS: Cumulative monthly medication orders at the CAH study sites ranged from a low of 12,535 in the first month of the study to a high of 18,257. Monthly rates of visual medication verification and clinical intervention ranged from 8.0% to 14.2% and from 1.3% to 3.1%, respectively. Overall, the most frequently identified QREs were transcription errors, which accounted for 2,389 interventions (43.3%); 2,078 interventions (37.7%) targeted prescribing-related QREs. The most frequently cited intervention codes were for dosage adjustments (n = 547), deep venous thrombosis prophylaxis (n = 437), pharmacokinetic consultation (n = 268), renal dosing (n = 182), and the prevention of minor (n = 148) and major (n = 94) adverse drug events. CONCLUSION: The study results indicate that the NDTP telepharmacy model is effective in identifying and resolving QREs in CAHs. The use of the telepharmacy services increased over the study period, suggesting that CAH practitioners became more comfortable using the technology on a regular basis to enhance patient safety.

Differences in medication errors between central and remote site telepharmacies.

OBJECTIVE: To examine differences in dispensing errors within community telepharmacy practices by comparing error rates across central sites (community telepharmacy sites with pharmacists present) and the corresponding remote sites, which are staffed by registered technicians and overseen by the central site pharmacist. DESIGN: Cross-sectional pilot study with a test group (remote sites) and comparison group (central sites). SETTING: 24 rural community telepharmacies (14 remote sites and 10 central sites). PARTICIPANTS: Pharmacy staff. INTERVENTION: The Pharmacy Quality Commitment (PQC) reporting system was integrated into the North Dakota Telepharmacy Project and used to track dispensing errors over a 45-month period. Both pharmacists and pharmacy technicians were trained on the use of the PQC system. The PQC system focused on two quality-related events (QREs): a "near miss" (i.e., a mistake discovered by the pharmacy staff before a medication reaches the patient) and an "error" (i.e., a mistake discovered after the patient leaves the pharmacy with the medication). MAIN OUTCOME MEASURES: The distribution of QREs across central and remote sites. RESULTS: The remote (central) telepharmacy group reported 47,078 (62,480) prescriptions and a QRE rate of 1.34% (1.43%). QREs at the remote sites were more likely than at the central sites to be caught at the final pharmacist check (58.2% vs. 40.8%, P < 0.01) and less likely to be caught by the patient (0.17% vs. 0.28%, P < 0.01). Remote sites were more likely to include incorrect directions (18.9% vs. 13.4%, P = 0.01) in the medication entry process. CONCLUSION: QRE rates for remote site and central site telepharmacies were consistent with each other and with national estimates in traditional community pharmacies. However, significant differences between central and remote sites existed based on how QREs arose and how they were caught. Pharmacists must recognize this fact and use diligence when working in a telepharmacy setting.

Do remote community telepharmacies have higher medication error rates than traditional community pharmacies? Evidence from the North Dakota Telepharmacy Project.

OBJECTIVE: To evaluate the differences in medication dispensing errors between remote telepharmacy sites (pharmacist not physically present) and standard community pharmacy sites (pharmacist physically present and no telepharmacy technology; comparison group). DESIGN: Pilot, cross-sectional, comparison study. SETTING: North Dakota from January 2005 to September 2008. PARTICIPANTS: Pharmacy staff at 14 remote telepharmacy sites and 8 comparison community pharmacies. INTERVENTION: The Pharmacy Quality Commitment (PQC) reporting system was incorporated into the North Dakota Telepharmacy Project. A session was conducted to train pharmacists and technicians on use of the PQC system. A quality-related event (QRE) was defined as either a near miss (i.e., mistake caught before reaching patient; pharmacy discovery), or an error (i.e., mistake discovered after patient received medication; patient discovery). MAIN OUTCOME MEASURE: QREs for prescriptions. RESULTS: During a 45-month period, the remote telepharmacy group reported 47,078 prescriptions and 631 QREs compared with 123,346 prescriptions and 1,002 QREs in the standard pharmacy group. Results for near misses (pharmacy discovery) and errors (patient discovery) for the remote and comparison sites were 553 and 887 and 78 and 125, respectively. Percentage of "where the mistake was caught" (i.e., pharmacist check) for the remote and comparison sites were 58% and 69%, respectively. CONCLUSION: This study reported a lower overall rate (1.0%) and a slight difference in medication dispensing error rates between remote telepharmacy sites (1.3%) and comparison sites (0.8%). Both rates are comparable with nationally reported levels (1.7% error rate for 50 pharmacies).

Is there a successful business case for telepharmacy?

The purpose of this study was to assess the financial operation of a Single Business Unit (SBU), consisting of one central retail pharmacy and two remote retail telepharmacies. Analyses of income statements and balance sheets for three consecutive years (2002-2004) were conducted. Several items from these statements were compared to the industry average. Gross profit increased from $260,093 in 2002 to $502,262 in 2004. The net operating income percent was 2.9 percentage points below the industry average in 2002, 3.9 percentage points below in 2003, and 1.3 percentage points above in 2004. The inventory turnover ratio remained consistently below the industry average, but it also increased over the period. This is an area of concern, given the high cost of pharmaceuticals and a higher likelihood of obsolescence that exists with a time-sensitive inventory. Despite these concerns, the overall trend for the SBU is positive. The rate of growth between 2002 and 2004 shows that it is getting close to median sales as reported in the NCPA Digest. The results of this study indicate that multiple locations become profitable when a sufficient volume of patients (sales) is reached, combined with efficient use of the pharmacist's time.