Implementation of pharmacy services in a telemedicine intensive care unit.

Purpose: The implementation of a remote intensive care unit (ICU) pharmacy service in a 13-hospital health system is discussed.

Summary: Significant challenges for small hospitals are timely, consistent delivery of critical care and being able to have highly experienced critical care physicians, nurses, and pharmacists available onsite within the ICU during all hours of the day. To remedy these problems, Aurora Health Care turned to telemedicine. All 246 ICU beds in the health system are connected to a remote, office-based ICU monitoring facility powered by the eICU, a telemedicine technology. The remote ICU is located in an independent facility. The staff consists of 5.2 full-time equivalent (FTE) pharmacists and 2.2 FTE pharmacy technicians and they monitor ICU patients at all of the hospitals in the system. Each remote ICU pharmacist was educated about expectations and is familiar with the different site processes and practices. All hospitals in the system were required to implement order-scanning technology to allow the remote ICU pharmacy staff to efficiently process orders. Computerized physician order entry, which results in orders being received directly by the pharmacy information system for verification, was also implemented within the system. The remote ICU pharmacists make recommendations for problems to either the hospital-based staff or the remote ICU team. Appropriate antimicrobial coverage and formulary support were the most common recommendations. Cost reduction is an important element of the remote ICU pharmacy service, but the primary motivation for implementation was to improve the quality of patient care.

Conclusion: Implementation of a remote ICU pharmacy service in a 13-hospital health system resulted in the provision of consistent pharmaceutical care while minimizing costs.