By Joe Rogers, RPh

FOR THE FIRST 25 OF THE 27 YEARS THAT I HAVE BEEN EMPLOYED BY St. Joseph’s Hospital in Eureka, California, we did not have a 24-hour hospital pharmacy. Like most of the 4,000 U.S. hospitals that do not offer 24/7 pharmacy services, we had neither the need nor the budget for it. However, in 2003, we began to seriously consider around-the-clock pharmacy service – not because of higher demand, but as part of our effort to enhance patient safety.

While our interest in improving patient safety increased, our budget did not. Adding the staff necessary for 24/7 service was nearly impossible, not only because of our limited budget, but also because of the limited supply of pharmacists in the marketplace. Recruiting new pharmacy school grads to rural areas can be a tough sell. So, in July of 2003, when we first learned of Cardinal Health’s Rxe-source, a pharmacy medication order review system designed for use during off hours, we were intrigued.

The Status-Quo
As a 140-bed hospital in rural California, 330 miles north of San Francisco, our off-hour pharmacy needs are generally not great, but there are always exceptions. As the largest hospital in the area, we offer acute care, cardiac surgery, catheterization, and radiation oncology, and we also receive trauma patients. Our average census is 100 patients, and our pharmacy employs six pharmacists. We are part of a private, non-profit network of 15 hospitals in California and Texas run by the Sisters of St. Joseph of Orange. Previously, during evening and holiday hours, when the pharmacy was closed, our doctors would write prescriptions that nurses or nursing supervisors would then fill. We followed state and JCAHO standards by having the day-shift pharmacy team retroactively review the order first thing in the morning. The system worked well, and it is still the status quo at most hospitals that do not offer 24/7 pharmacy services. But we were committed to raising the bar on patient safety, even though the current system was working.

Going 24/7 Without Adding Staff
By the end of 2003, we had decided that Rxe-source was an ideal fit for our needs. The service provides a timely analysis of medication orders by licensed pharmacists, before medications are administered to patients, while also controlling costs, much to the delight of administration.

The night shifts at St. Joseph’s have become increasingly more busy in recent years. It is not uncommon to have surgeries in the evenings; admissions seem to occur later and later; and we receive many referrals from other hospitals, often at night. This increase in activity only made our concerns regarding patient safety more urgent. Even though we had not budgeted for the Rxe-source service, our hospital administration believed that patient safety was a worthy reason to go off budget. And because the service comes at a fraction of the projected cost to expand our staff, our COO insisted that we implement it right away.

In February 2004, we went live with Rxe-source. Our usual hours of operation are 6:30AM to 9:00PM on weekdays and 7:30AM to 5:30PM on weekends and holidays. During the hours when the pharmacy is closed, Rxe-source becomes an extension of St. Joseph’s Hospital. The service has pharmacists located in six regional pharmacy service centers across the country. We are serviced by a dedicated team located in Orange County, California.

The service includes the review and entry of all medication orders into the hospital pharmacy information system, clinical consultations, daily debriefing activity reports, and additional coverage options in case of emergencies. After receiving medication orders from our nursing staff, the remote pharmacy team can access our Meditech information system to verify the order, view the patient record, review lab results, and access our substitution schedule and formulary requirements. The Rxe-source pharmacist approves orders using our computer system, and the order is sent to our Pyxis MedStation dispensing systems. Rxe-source can interface with any hospital computer and medication dispensing system. Nurses can then retrieve the approved drugs from the dispensing system on their floor. The process is seamless.

Results and Future Plans
Since St. Joseph’s implemented Rxesource, JCAHO has revised its standards, requiring that all pharmacy orders be reviewed before they are given to patients. Without this innovative service, we would currently be facing an enormous expenditure to expand our staff and services. Now, we are already in compliance at a fraction of the cost.

One of our next steps for improving the system is converting to digital orders. Currently, our nurses have to fax handwritten orders to the Rxe-source pharmacy service center. We will soon begin scanning the paper orders and sending digital files over the Rxe-source network. Based on our positive results, two other hospitals in our network have become Rxe-source customers and are enjoying the benefits of 24/7 pharmacy services without the staffing overhead and recruitment challenges.

Joe Rogers, RPh, is the pharmacy director at St. Joseph’s Hospital in Eureka, California, where he has worked for more than 28 years. He is a graduate of the Oregon State University Pharmacy School.