Marcia Frellick

December 10, 2014

A telepharmacy pilot project allowing licensed pharmacists to supervise the mixing of chemotherapy by pharmacy technicians in areas up to 90 minutes from a prominent cancer center has received national recognition.

The Yale–New Haven Hospital in Connecticut received the $50,000 excellence award for medication-use safety from the American Society of Health-System Pharmacists (ASHP) Research and Education Foundation at the Midyear Clinical Meeting in Orange County, California.

In 2011, the Smilow Cancer Hospital at the Yale–New Haven Hospital acquired nine oncology physician practices and was faced with bringing them in line with the hospital system's standards of care, according to Howard Cohen, RPh, from Smilow.

"They didn't have pharmacists. They had nurses who prepared all the chemotherapy doses," Dr Cohen said.

Rather than having pharmacists on site at all locations, they came up with a way to use digital photography and an audiovisual link between Smilow and technicians at each location so the pharmacists could observe the mixing of the chemotherapy infusions remotely. They also developed a bar code system so that the technician had to use the right medicine or the technology would shut down after scanning the code.

At several steps in the process, the technicians are prompted to take a digital picture of the exact amount added to the solution. If they don't take the picture, the system doesn't allow them to proceed, Dr Cohen explained. When the mixture is complete, a second pharmacist reviews each step.

"We have five checks within the system before the product is released to the patient, which is exceptional," he said.

Project Required a Change in State Law

However, changing operations meant changing state law, because telepharmacy was not legal in Connecticut at the time.

The team presented its proposal to the state, and the law was changed on May 14, 2012 to allow the telepharmacy model for mixing intravenous infusions. With the changes, cancer patients could stay closer to home for treatment.

"Patients like to come to community settings rather than the big academic institutions," Dr Cohen explained. Part of the project was designed to decrease the wait time for patients coming into those care centers, and the time actually decreased by an average of 20 minutes, he reported.

The system allows flexibility to accommodate changes in the workload at offices 5 to 90 minutes from the main campus, said Eric Cabie, RPh, from the Yale–New Haven Hospital. It also ensures continuity of care in bad weather or in case of staff illness, he told Medscape Medical News.

This project stood out primarily because it solves an issue more and more health systems will face as they acquire physician practices and need to bring them up to systemwide standards, and because it changed state law, explained Daniel Cobaugh, PharmD, who is vice president of the ASHP Research and Education Foundation and led the team that selected the winning submissions. The initiative also helps pharmacists spend more time practicing at the top of their license, he said.

"They used telepharmacy to support the dispensing process for the chemotherapy medications so that they could enable pharmacists at their sites to spend their time providing direct patient care," he said. "That was impressive."

The award is supported by the Cardinal Health Foundation. Dr Cohen and Dr Cobaugh have disclosed no relevant financial relationships. Dr Cabie is on the speaker board for Baxter International.

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