Providing nighttime pharmaceutical services through telepharmacy.

A nighttime telepharmacy service serving a community hospital is described. At a 340-bed acute care community hospital, the level of nighttime activity related to medication use did not support the establishment of a full night pharmacy shift. After-hours access to medications was mostly the responsibility of nursing and medical staff using a separate night closet, automated dispensing machines, and limited floor stock. Pharmacists reviewed new orders and missing doses during the following day shift. An innovative practice model that combined an outsourced telepharmacy service and the traditional oncall pharmacist service was implemented to improve services at night. Prospective order review, drug information services, and clinical pharmacy consultations were all provided under the new model. Nurses and physicians used the service extensively. A total of 1039 drug orders were reviewed by the telepharmacy service during the first three months, with 29% of these orders representing high-risk therapies. Most orders were submitted by the critical care areas, the medical-surgical units, and the emergency department. Feedback from the hospital staff concerning the service was favorable, and physician leaders asked that the service be expanded to take oral orders from physicians at night. A nighttime telepharmacy service was successfully implemented at a community hospital to provide medication order review, resolution of drug-related problems, and drug information and clinical pharmacy services.