By Sammu Dhaliwall

With its large land mass and population density in relatively few pockets, Canada’s hospital pharmacy departments across the country face immense challenges providing pharmacist services.  Many remote and rural communities are unable to recruit the services of a pharmacist for daytime work, and don’t have the economies of scale to keep a full time pharmacist busy.  As technologies have advanced to improve the safety of medication distribution systems, even urban hospitals in populated areas have yet to embrace the true safety nets that pharmacists bring when medication orders are verified around-the-clock.  The vast majority of hospital pharmacies still shut down overnight, despite the fact that healthcare is 24/7 and many of our sickest patients are ordered medications overnight.   For such reasons, telepharmacy has been a growing service offer for health institutions over the past 15 years.

The Canadian Society of Hospital Pharmacists defines telepharmacy as “The use of telecommunications technology to facilitate or enable the delivery of high-quality pharmacy services in situations where the patient or healthcare team does not have direct (in-person) contact with pharmacy staff.”1 Telepharmacy can be used to in many ways, for example, clinically review new orders 24/7, remotely check sterile IV preparations, or provide counseling to patients at discharge from the hospital.

The first recognized telepharmacy services in Canada were within some of the health regions of British Columbia and New Brunswick in 2003, in which larger regional hospitals helped review orders for certain small hospitals that didn’t have regular onsite pharmacists to help support the patients.  In 2004, a private telepharmacy company started providing remote clinical order review to a hospital in Moose Factory, Ontario, as the hospital was not able to recruit a pharmacist.  This telepharmacy company today services over 45 hospitals, providing remote clinical order review around-the-clock and additionally helps pharmacy departments meet medication management standards by experimenting with videoconference technologies (including Ontario Telemedicine Network’s secure links to healthcare institutions).  While there are many other current examples of telepharmacy services provided across the country, large gaps remain, leaving many deficiencies in pharmacy services.

Technologies utilized to provide Telepharmacy in Canada include:

Medication Order Management solutions

Allowing nurses to scan physician medication orders securely to the remote pharmacist in hospitals which are still mostly paper-based

Enable one pharmacist to manage multiple hospitals simultaneously with clinical support and specific medication reviews overnight to improve efficiencies and safety

Videoconference solutions

Allowing pharmacists to communicate with patients for education and discharge counselling

Enabling pharmacists to communicate with physicians, nurses and other healthcare.

Considering the ethics of e-health: Telemedicine, telehealth and telesitting

Remote camera verification solutions (which bring telepharmacy support to one of the highest risk areas of hospital pharmacy – compounding of sterile products, chemotherapy, and non-sterile medications):

Allowing for remote check of compounded products by pharmacist or pharmacy technician and future traceability of products if errors are suspected or recalls occur

Successfully implemented in Newfoundland  & Labrador enabling chemotherapy products to be prepared in remote hospitals, allowing patients to receive life-saving therapy closer to home

Although telepharmacy has been used by Canadian hospitals for over 15 years, there is a need for expansion of its use in the future, to allow for advancement in how pharmacy services are delivered to and received by patients, and to provide all patient, regardless of geographical location in Canada, the same standard of care.

This article was submitted by Sammu Dhaliwall, Telepharmacy Services Solutions.