Implementation, Evolution and Impact of ICU Telepharmacy Services Across a Health care System

Abstract

Purpose: A review of the implementation and development of telepharmacy services that ensure access to a critical care-trained pharmacist across a healthcare system. Summary: Teleintensive care unit (tele-ICU) services use audio, video, and electronic databases to assist bedside caregivers. Telepharmacy, as defined by the American Society of Health-System Pharmacists, is a method in which a pharmacist uses telecommunication technology to oversee aspects of pharmacy operations or provide patient care services. Telepharmacists can ensure accurate and timely order verification, recommend interventions to improve patient care, provide drug information to clinicians, assist in standardization of care, and promote medication safety. This tele-ICU pharmacy team is one of the only entirely clinical-based tele-ICU pharmacy models among the tele-ICU programs across the United States. The use of technology for customized alert generation and intervention proposal with medication orders and chart notation are unique. In a 34-month period from September 2015 to July 2018, more than 110 000 alerts were generated and 13 000 interventions were performed by telepharmacists. Conclusions: Tele-ICU pharmacists employ limited resources to provide critical care pharmacy expertise to multiple sites within a healthcare system during nontraditional hours with documented clinical and financial benefits. Further study is needed to determine the impact of tele-ICU pharmacists on ICU and hospital length of stay, morbidity, and mortality.

Keywords: critical care; pharmaceutical care; tele-ICU; telemedicine; telepharmacy.

Figure 1.

Second-shift tele-ICU pharmacist workflow. Note. Tele-ICU = tele–intensive care unit; EMR = electronic medical record.

Figure 2.

Evolution of virtual critical care and telepharmacy services. Note. ICU = intensive care unit.

Figure 3.

Alerts generated and interventions performed. Note. Alerts received and interventions documented from September 15, 2015, to July 31, 2018. No alerts were generated for medication management, BCID calls, SUP, or VTE prophylaxis as interventions in these categories are stimulated by electronic medical record review or laboratory calls rather than alerts. BCID = blood culture identification; SUP = stress ulcer prophylaxis; VTE = venous thromboembolism.

Figure 4.

Intervention activities per shift from July 2017 to July 2018 with both first and second shifts operating concurrently.