Kansas launches remote supervision for hospital pharmacy techs

Chalk up a first for hospital pharmacists in Kansas. In November last year, Mark Gagnon, PharmD, used video conferencing to supervise a pharmacy technician working in a hospital 200 miles across the state. It was the first use of the new state board regulation designed to allow remote supervision of hospital pharmacy technicians.

"We are letting the medical care facility have electronic access to a supervising pharmacist electronically," said Debra Billingsley, executive secretary, Kansas State Board of Pharmacy. "An on-site pharmacist can be anywhere in the facility while supervising a technician and we think this is even more effective because the pharmacist is watching the entire technician process and creating an archived electronic record. We think Kansas is the first state to specifically authorize this kind of remote supervision for pharmacy technicians working in medical facilities."

"Remote supervision or something like it is inevitable," said Tim Larson, PharmD, director of pharmacy for Cardinal's remote medication order entry facility in Illinois. The center currently handles pharmacy orders for hospitals in 10 states. Cardinal does not currently offer remote supervision, but several clients have expressed interest in the idea, he said.

"You almost have to do something like this to have a pharmacist review all orders prospectively in smaller and more rural facilities that can't afford a pharmacist 24/7. There are some cautions to be sure things are done properly and safely, but as technology becomes more affordable, it opens a lot of doors."

The key concerns are patient safety and appropriate medication use, Larson continued. Pharmacy boards are also concerned that hospitals may try to cut pharmacy staff and move to remote supervision.

Kansas designed its remote supervision regulations to avoid that kind of impact on pharmacy employment, Billingsly said.

"Some people think it means they don't need a pharmacist at all," she said. "That is not the case. Approval takes some serious convincing on our part."

Gagnon launched a remote order entry service for rural Kansas hospitals in 2005. He is now Via Christi Health ePharmacy director in Wichita. At the moment, the only approved remote supervision site is Hiawatha Community Hospital, a Via Christi facility in the northeast corner of the state that is approximately 200 miles away.

Hiawatha has only 1 pharmacist who is on 24-hour call. If she is out sick or on vacation, the hospital has to rely on remote medication order entry to fill orders. Other hospitals have a pharmacist on duty as little as a half-day per week.

"We see remote supervision as the next logical step beyond remote medication order entry," Gagnon explained. "As long as a hospital has a technician, remote supervision gives them the same kind of pharmacy access and medication safety they would have with a pharmacist on duty 24/7."

Real-time electronic presence is already used for medical consultations and other health-related tasks where specialists are not physically available, said Carmen Catizone, MS, RPh, DPh, executive director, National Association of Boards of Pharmacy. It's no surprise that pharmacists are using the same technology to extend pharmacy services.

"The goal is to achieve the same objectives of patient safety and appropriate medication use as if the pharmacist was there in person," Catizone said.

The Joint Commission has not taken a position on remote supervision, noted spokesman Bret Coons. From its perspective, a hospital pharmacy with a technician on site and remote supervision that meets state requirements is subject to the same standards as any other hospital pharmacy that is open and operating.