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How telehealth can improve medication management and patient safety

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Medication errors account for at least one death each day and injuries to an estimated 1.3 million people annually. But while implementing new workflows can put a dent in this problem, making a significant impact requires a huge dedication of resources.

What’s not typically part of the discussion? How telehealth can improve medication safety.

While telehealth’s power to enhance acute-care programs is undisputed, its ability to improve the less-prominent (but equally important) medication reconciliation and safety processes is largely untested, and potentially eyebrow raising.

But as the experiences of a handful of healthcare organizations demonstrate, a system-wide telehealth platform could prove to be an unsung hero when it comes to minimizing the risk for adverse drug-related events, while maximizing efficiencies.

Although EHRs can reduce errors stemming from manual prescribing practices, hospitals are still experiencing an uncomfortably high level of errors in prescribing, transcribing or dispensing medication, which can lead to harmful drug interactions, allergic reactions and other problems.

But it is impossible to point the finger at a single culprit, as one recent study noted. For example, we know that patients don’t always self-report medications—especially over-the-counter drugs such as vitamins, sleeping aids or laxatives.

We also know that true interoperability—whereupon all disparate systems communicate like family—is still somewhat aspirational: Unless a hospital has the means and the will to communicate outside of its network, an ED nurse or pharmacist is often left in the dark about what medications a patient has used (such as opioids, insulin or something else) within a particular time frame (for example, a week, a month or longer).

Also, the problem of alert fatigue, which plagues physicians with incessant beeps from well-intended notification systems and EHRs, still persists in spite of advances in “smart” notification tools and clinical decision support systems.

Such challenges, in light of healthcare information technology advancements, beg a more difficult question—is there any tool, protocol, work-around or multi-pronged approach that can truly nudge the needle forward, creating a new standard for medication safety that sets the bar across the industry?

In acknowledging these challenges, one U.S. hospital we work with decided, in recent months, that it needed to figure out new ways for its system-wide telehealth platform to support patient-safety efforts.

Like many hospitals, this facility provides patients with a medication consult with a pharmacist on admission; more than half of patients admitted to the ED (about 60 percent) require this service. Healthcare providers estimated the medication error rate hovered around the 70 percent mark, in part because existing consults took too long (because of the lack of a readily available pharmacist or other health professional to make rapid decisions at the point of care).

Nevertheless, the hospital wanted to improve its emergency department intake processes and strengthen other programs with the addition of a system-wide telehealth platform. Having already seen a dramatic reduction in wait times due to the implementation of the virtual care solution, which helped staff triage care more efficiently, the hospital agreed to use its platform to address medication management practices.

The outcome was better than expected. Moving consultations to a telehealth platform freed up dozens of hours of time for clinical and pharmacy staff. Today, after a patient presents at the hospital, the patient is moved into a hospital bay, where he or she engages in a video consultation with a pharmacist. The risk of discrepancies is drastically reduced because patients connect directly with pharmacists, instead of rattling off lists of medications to multiple staff members, and because a pharmacist can conduct the consult in the same program that she verifies, completes, and archives each patient case.

This new process has worked so effectively in the pilot phase that the hospital plans to expand its telehealth use in coming months.

Another aspect to the hospital’s medication reconciliation efforts addressed by telehealth is the hospital’s pharmacy injection program. Pharmacists are required to watch pharmacy techs when they are in a clean room hood, mixing syringes and compounding drugs.

Through the use of telehealth carts, the pharmacist can now observe the techs remotely and not have to move into the clean room (which requires an individual to go through a sterilization process and wear a clean room suit). Because the telehealth application is equipped with cameras that allow a pharmacist to zoom in and check labels on the drug to make sure they are using the correct package size and dose, quality and accuracy have improved.

While these are just two examples of telehealth’s potential to address medication reconciliation, the opportunities to reduce errors and improve patient outcomes are potentially endless. As healthcare organizations consider their plans for system-wide telehealth, they should look beyond the low-hanging fruit, or obvious opportunities. After all, a platform is only as good as its ability to support and enhance solutions to multiple hospital pain points—and exceed healthcare leaders’ expectations.

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