A Cost Study of Virtual Pharmacists at a Rural Hospital in Florida

STATEMENT OF THE PROBLEM: Rural hospitals have difficulty recruiting and retaining qualified clinical staff. Pharmacists are in high demand, making these workers especially difficult to recruit. Many clinical services can now be provided remotely. These include consultations, interpretation of radiographs and critical care unit monitoring. Pharmacist services can also be provided remotely, through the use of electronic health records, electronic medication dispensing systems and webcams. This study looks at the cost effectiveness of employing pharmacists for night coverage at one rural hospital versus utilizing a remote, off-site, virtual pharmacist. METHODOLOGY: Lakeside Medical Center is a 70-bed, Joint Commission accredited hospital located in rural Palm Beach County, FL. The hospital has had difficulty recruiting pharmacists, and historically nursing supervisors have been utilized to provide pharmacy services during shifts when there is no pharmacy coverage. This practice has the potential to result in medication errors. One method to address this concern is to use a virtual pharmacist. The virtual pharmacist is a state of Florida licensed pharmacist, located in an off-site location, who is able to access the electronic medical record, review the patient profile and review new orders. The virtual pharmacist is also able to visually verify medications, utilizing a web cam. This is critical for unusual medications that are not loaded into the hospital's electronic medication dispensing system. This visual verification is also critical if any mixing of intravenous medications is performed. The cost of the virtual pharmacist service is priced by each fill line that the pharmacist reviews. The cost of staff pharmacists is the sum of salary and benefits for the number of positions required to provide coverage. RESULTS: In the 2010 fiscal year, there were 36,471 pharmacy fills made in hours when pharmacists were not scheduled to work. The cost for these fills to be done by a virtual pharmacist would be $155,002, when priced at $4.25 per fill line. If staff pharmacists were hired to do these fills, the cost for the same work would be $280,080. CONCLUSIONS: Utilizing off-site, virtual pharmacist is cost effective for rural hospitals. There is an added safety benefit in having a pharmacist review all medications before they are dispensed.