Skip to main content

E-Pharmacy Catches Drug Mistakes for Rural Hospitals in Five States

 |  By cclark@healthleadersmedia.com  
   May 05, 2010

It's always refreshing to hear about a big, geographically diverse hospital system that tries to find solutions for its smallest facilities, and succeeds. Especially when doing so saves tons of money and prevents medication errors that endanger patients.

Welcome to the world of e-pharmacy, and Bravo Banner Health.

The non-profit, Phoenix-based 22-hospital system that stretches across seven states, from Alaska to Nebraska, is doing just that for eight of its small, rural facilities that don't have pharmacy staff to review prescriptions around-the-clock.

"Previously when the hospital's pharmacist went off duty, the drugs would be reviewed the next day," possibly after critical mistakes could have been made, says Richard Einhellig, director of pharmacy at Northern Colorado Medical Center in Greeley, 60 miles northeast of Denver.

With its remote medication order processing service, now in place for about two years, a crew of pharmacists review 9,000 prescription orders a month for those eight small—25-bed to 40-bed—hospitals in five states: Colorado, Wyoming, Nebraska and Nevada and even one hospital sitting amid northern California's mountains, 1,102 miles away.

Einhellig or one of his staff can pull up a digital image of each physician's order that was handwritten for a patient far away. Those orders are checked for "right dose, right patient, right drug, and appropriate indication for use," by comparing these prescriptions against the patient's electronic medical record, all visible on the Greeley computer monitor, he says.

After review, the electronic system sends a message to automated dispensing prescription drug cabinets at each hospital that allows those medications to be released to the patients.

Einhellig says the system helps Banner's smaller hospitals meet a new Joint Commission patient safety goal, which says that a pharmacist should read all prescriptions before they reach the patient.

"What you could say is that for those hospitals that are limited to one pharmacist who works 40-hours a week, we're providing an additional 128-hours per week of pharmacy review that formerly would have happened retrospectively," Einhellig says.

Recently, he recalls, "We intervened in a situation where an insulin dose ordered turned out to be two times too high—a result of a miscommunication with the family member." Einhellig's team questioned the dose, the nurse clarified the order and a potentially dangerous situation was averted.

"And there have been drug-allergy interactions that I have caught as well," he says. "I saw an order for a medication that was a penicillin derivative, piperacillin, but the patient's chart showed a penicillin allergy." Einhellig called the nurse at the hospital and stopped the medication, and another adverse event was averted.

Along with the patient safety benefits, the financial savings have been huge.

Einhellig says that Banner estimates it saves $960,000 annually compared with using an outsourced company, and $2.7 million annually if Banner had to staff each facility with an on-site pharmacist 24 hours a day, seven days a week and 365 days a year.

Einhellig says he can't quantify how much the program has saved in avoidance of prescription mistakes. However, in 2006 an Institute of Medicine report estimated the cost of treating drug-related injuries occurring in hospitals at a "conservative" $3.5 billion a year.

"Medication errors are among the most common medical errors, harming at least 1.5 million people every year," the IOM report said.

Banner Health has so far spent $180 million to install its remote medication order processing system throughout its hospitals, but Einhellig says it's been well-worth it.

Now in place almost two years, the new system "catches errors almost every day," says Ed Maurino, director of pharmacy at Banner Lassen Medical Center, a 25-bed critical access facility in Susanville, 1,100 miles away from Greeley.

"There's just so many things that they can catch that we weren't able to before," Maurino says. Errors that could cause major adverse drug-drug or drug-patient reactions might include a drug that might be bad for a patient with a low creatinine clearance rate, he says.

Einhellig's team reviews prescriptions for East Morgan County Hospital in Brush and Sterling Regional Medical Center, both in Colorado; Ogallala Community Hospital in Nebraska; Banner Churchill Community Hospital in Fallon, NV; and three hospitals in Wyoming: Torrington Community, Platte County Memorial in Wheatland and Washakie Medical Center in Worland.

All are 25-bed hospitals except for Churchill, which has 40 beds, and Sterling, which has 36.

Kerri Kilgore, director of pharmacy at Banner's Torrington Community Hospital, 151 miles to the east of Greeley, says the system is very helpful to her and her nurses. "They scan in the electronic order [to Greeley]," a process that seems to run smoothly. And it's given her some valued peace of mind.

"It used to be that it was just me, with phone calls at all hours of the night," Kilgore says. Now the off-hour interruptions are greatly minimized, except for emergencies when Kilgore is called in to administer a sensitive intravenous drug.

"It's nice to have a backup, and not have it be always be just me, 24-hours a day," she says.

Though the results have so far been promising, the process has had some challenges. One problem that they needed to overcome was dealing with different formularies available for different groups of patients in different states, and the varying ways hospitals stocked their automated dispensing machines. Once they addressed that, the program has been moving along smoothly.

Bravo Banner Health.


Note: You can sign up to receive HealthLeaders Media Community and Rural Hospital Weekly, a free weekly e-newsletter that provides news and information tailored to the specific needs of community hospitals.

Tagged Under:


Get the latest on healthcare leadership in your inbox.