Implementation of Pharmacy Services in a Telemedicine Intensive Care Unit
Thomas W. Woller, M.S., FASHP, Tracy M. Meidl, Pharm.D., Arlene M. Iglar, M.S., and Dennis G. Brierton, Pharm.D.
Aurora Health Care, Milwaukee, Wisconsin
Telemedicine is a new and creative concept that healthcare organizations are utilizing to provide patient care while simultaneously decreasing healthcare costs. Our 13-hospital healthcare system includes several hospitals that are located in rural communities. One significant challenge for these small hospitals is timely, consistent delivery of critical care. In many small hospitals, it is logistically impossible to have critical care physicians, nurses, and pharmacists available on-site within the Intensive Care Unit (ICU) during all hours of the day. In 2004, our system implemented a form of telemedicine in order to provide centralized monitoring of all 246 intensive care unit beds in the system. Monitoring is conducted from a large, centrally located office by nurses and physicians who have access to the patient’s electronic medical record as well as to video and audio feeds from each patient room.
In early 2006, approval was sought and received to add pharmacy services to the telemedicine unit of our healthcare system. As of March 2007, a fully functional telemedicine pharmacy service was implemented,for all Aurora hospitals. Services provided included 24-hour coverage for clinical monitoring of patients across the system and after-hours order-entry coverage for the smaller hospitals that did not have an on-site pharmacist during the overnight shift. The goals of the pharmacy service were to improve the quality of patient care, reduce unnecessary drug expense, and improve service to the hospitals.
Following implementation of this service, pharmacists were asked to record interventions that resulted in improved quality or cost outcomes. During a three-month data collection period, pharmacists recorded 1093 interventions that improved the quality of patient care. The most common interventions were changes to antimicrobial therapy, drug therapy questions, and formulary support. Financial projections based on the data collection period indicate that pharmacist interventions resulted in an annualized drug cost savings of $489,100. In addition, order entry turnaround time, indicative of internal customer satisfaction, improved dramatically.
The addition of critical care trained pharmacists to the staff at the telemedicine unit has proven to be an effective way to extend the unique expertise of these pharmacists to patients in all of our hospitals. The implementation of a 24-hour pharmacy service as a part of our healthcare system’s telemedicine unit has demonstrated improved patient care quality outcomes, reduced unnecessary drug expense, and improved service for all the hospitals in our system.
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