2014 Award Recipient: Yale-New Haven Hospital

New Haven, Connecticut
Moving Oncology Care Closer to Home: Pharmacy Leadership Makes a Difference


Background

The Smilow Cancer Hospital at Yale-New Haven Hospital, a National Comprehensive Cancer Network (NCCN) and National Cancer Institute (NCI) designated cancer hospital, acquired nine oncology physician practices and integrated them into its cancer network. As part of a provider-based organization, the oncology practices needed to provide the same level of patient care, quality, safety and regulatory compliance as the main health system, including introduction of a pharmacist care model.

The hospital’s Pharmacy Department was challenged to develop this high-quality service for all locations while overcoming significant regulatory hurdles, limited resources, wide geographical diversity and multiple facility locations. Connecticut required licensed pharmacists to directly supervise the work of pharmacy technicians. This state law means a supervising pharmacist must be physically present in the area where the technician works.

Pharmacy leadership–in collaboration with nursing, medical staff and the hospital’s community and government relations personnel--developed an innovative “telepharmacy” model to meet all regulatory requirements and provide safe, high-quality and efficient patient care that met hospital standards regarding chemotherapy use at multiple physician practice sites.

Methods
A pilot was developed and approved by the Connecticut regulatory agencies. The pilot was designed to demonstrate the safety and quality of a pharmacy-provided medication management process in which the health system’s main pharmacy supported off-site oncology infusion centers.

The goal was to use telepharmacy to electronically capture and verify each step in the ordering, verification and preparation of intravenous chemotherapy. By directly linking the pharmacist and technician using audio/video imaging and an electronic workflow system via the Internet, in-process review and verification of the chemotherapy admixture by pharmacy technicians was performed safely and in regulatory compliance under a pharmacist’s supervision. The technology enabled pharmacist-led clinical and patient care activities that improved the patient experience.

Results
Data collected during the 8-month pilot demonstrated the technology capabilities of identifying and preventing of 1.7 percent compounding errors.  While many of these errors would have been prevented through a manual review/validation process, the value of error identification and cataloging through technology allowed the health system to better understand potential risk and system failures. As a result, overall safety and system improvements were found.

The success of the telepharmacy pilot resulted in Connecticut drug law changing to permit all hospitals in the state to use telepharmacy.  

The telepharmacy pilot and its data-driven component results included:
• A 20-minute reduction in chemotherapy verification and compounding time.
• An improvement to 97.7 percent utilization of the bar-code enabled technology in the chemotherapy compounding process.
• An increased capture rate of pharmacist clinical intervention metrics that demonstrated advanced clinical practice activities.

Conclusion
This innovative practice model advances the goal of “Keeping Cancer Care Close to Home” while providing patients with high-quality and exceptional patient care. It promoted the role of clinical pharmacists and pharmacy technicians as vital members of the patient care team.  The project showed how technology can enable advanced pharmacist clinical support for safe and effective cancer medication treatments in remote locations. The pilot’s success led to approval of a change to Connecticut State Drug Law on May 14, 2012, authorizing the telepharmacy model to be used broadly in the state. 

Interprofessional Team

Eric D. Cabie, R.Ph., M.B.A., Team Chair
Manager, Oncology Pharmacy Operations
Yale-New Haven Hospital

Nancy Beaulieu, R.Ph., BCOP
Pharmacy Manager
Smilow Care Centers

Jacqueline Blake, Esq.
Senior Government Relations Officer
Yale-New Haven Hospital

Anne Chiang, M.D.
Chief Medical Officer
Smilow Cancer Network

Howard Cohen, R.Ph., M.S., FASHP
Associate Director, Oncology Pharmacy Services
Yale-New Haven Hospital

Diane Corjulo, R.N.
Clinical Program Manager
Smilow Care Centers

Monica Fradkin, R.N., M.P.H.
Manager, Oncology Practice and Education
Yale-New Haven Hospital

Amanda Kardas, CPhT
Oncology Pharmacy Technician
Yale-New Haven Hospital

Lorraine Lee, R.Ph., M.H.A.
Executive Director, Corporate Pharmacy Services
Yale-New Haven Hospital

Arthur Lemay, R.Ph., M.S.
Executive Director
Smilow Care Network

Lisa Shomsky, R.N.
Clinical Program Manager
Smilow Care Centers

Jerry Siegel, Pharm.D., FASHP
Yale-New Haven Hospital

Sergio Toni, R.Ph., M.P.A.
Clinical Oncology Pharmacist
Yale-New Haven Hospital
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