ASHP guidelines foster remote pharmacy management

Key Points

Pharmacy directors who want to - or have to - operate 24/7 but don't have the staff to cover all 3 shifts have a new ally, the American Society of Health-System Pharmacists (ASHP). In April, ASHP issued its first-ever guidelines for remote medication order processing (RMOP).

"We are in a resource-strapped healthcare environment where it is not always possible to have a pharmacist on duty 24 hours a day," said Anthea Francis, RPh, director, section of inpatient care practitioners, ASHP. "On the practical side, a hospital may not be able to hire the pharmacists it needs. Remote pharmacy management is an alternative."

Not being able to hire a pharmacist was the spot Richard Stomackin, RPh, found himself in 5 years ago. As pharmacy director at Lewistown Hospital, a 139-bed facility in rural Lewistown, Pa., Stomackin suddenly needed a full third shift to support a pending move to electronic medication administration records (eMARs).

Stomackin signed with Cardinal Health's Rxe-source, then one of the few national RMOP providers. He still uses the service as coverage for third shift and as a resource while Lewistown builds a computerized physician order-entry system that also requires 24-hour pharmacy support 7 days a week.

Lewistown Hospital is not unusual. The latest ASHP survey found that nearly 80% of hospitals nationwide lack pharmacy coverage at some point during a typical week. The widespread lack of 24/7 coverage combined with mandates to enhance hospital technology are fueling a surge of interest in remote pharmacy management. Community pharmacy is grappling with similar issues as telepharmacy replaces pharmacists in small-town and rural healthcare settings.

It's not just rural hospitals that use RMOP, said Kelly Morrison, Rxe-source director of sales and marketing and a member of the ASHP committee that drafted the new guidelines. A growing number of health-system pharmacies also need help covering nights and weekends. Some systems use workload-balancing programs that include RMOP; others turn to outside providers.

ASHP believes that it is impossible to describe a standard of practice for an area of pharmacy that is continually evolving, for which practice models would vary based upon state regulations, and for which practice standards would vary based upon the health-system setting, Francis said. Instead, the guidelines are to serve as a foundation that practitioners can build upon and adopt to suit their unique practice settings. "This is an evolving practice," said Francis.