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

Cheryl Clark, for HealthLeaders Media, May 5, 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.

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