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Telepharmacy: Guidelines O F F I C I A L P U B L I C A T I O N G U I D E L I N E S Telepharmacy: Guidelines 2018 Telepharmacy: Guidelines Published by the Canadian Society of Hospital Pharmacists (CSHP), Ottawa, Ontario. 2018 Suggested citation: Telepharmacy: Guidelines. Ottawa (ON). Canadian Society of Hospital Pharmacists; 2018. © Canadian Society of Hospital Pharmacists, 2018 All rights reserved. Publications of the Canadian Society of Hospital Pharmacists (CSHP) can be obtained from: 30 Concourse Gate, Unit 3 Ottawa ON K2E 7V7 Telephone: 613.736.9733 Fax: 613.736.5660 Internet: www.cshp.ca Requests for permission to reproduce or translate CSHP official publications, whether for sale or for non-commercial distribution, should be addressed to the CSHP Publications Administrator through the above contact information. This publication represents the views of CSHP. Its use was approved by CSHP’s Board in 2018 after careful consideration of the evidence available. All reasonable precautions have been taken by CSHP to verify the information contained in this publication. CSHP is a national not-for-profit, voluntary organization of pharmacists committed to patient care in hospitals or other collaborative healthcare settings. CSHP is not a regulation-setting organization. This published material is being distributed without warranty of any kind, either expressed or implied. It is the responsibility of the user of the publication to judge its suitability for his or her particular purpose within the context of his or her practice and the applicable legislative framework. In no event shall the CSHP or any persons involved in the development and review of this publication be liable for damages arising from its use. CSHP did not accept financial support from an external source for the development, production, or dissemination of this publication. The Official Publications of CSHP are subject to periodic review, and suggestions for their improvement are welcomed. Where more than one version of a publication exists, the most recent version replaces any former versions. Users of the CSHP’s Official Publications are advised to check CSHP’s website for the most recent version of any Official Publication. All inquiries regarding this publication, including requests for interpretation, should be addressed to the CSHP through the above contact information. Introduction outcomes, financial sustainability, and appropriate scopes of practice for healthcare professionals. Telepharmacy This is the first edition of guidelines from the Canadian can address all of these expectations by strengthening Society of Hospital Pharmacists (CSHP) regarding the the profession’s alignment with the healthcare needs of provision of telepharmacy services. The guidelines were Canadians and responding to stresses on the healthcare approved by the CSHP Board in 2018. system. These guidelines were developed by a group of CSHP members with experience in telepharmacy, in collaboration 1 Scope with CSHP staff. The guidelines are consensus-based, These guidelines were developed to support pharmacy reflecting current best practice in the provision of personnel in deciding whether to provide or receive services telepharmacy services. via telepharmacy, in preparing for implementation, and in providing ongoing service support. The guidelines apply The term “telepharmacy” refers to the use of to institutional settings such as hospitals, ambulatory telecommunications technology to facilitate or enable the care clinics, and long-term care facilities. The information delivery of high-quality pharmacy services in situations presented here is intended as a general guide, reflecting where the patient or healthcare team does not have direct best or leading practices, and may be adapted to meet the (in-person) contact with pharmacy staff. Telehealth, of needs of individual pharmacies, within the context of a risk which telepharmacy is one component, includes 4 domains assessment. of application: synchronous video (2-way interaction), asynchronous content (provision of recorded health record, These guidelines are intended to complement all relevant stored audio or video, etc.), remote patient monitoring (e.g., legislation (federal/provincial/territorial) and accepted telemetry), and mobile health (using mobile devices).1 Each patient safety practices; they should not be used as of these domains can be extrapolated to telepharmacy. justification to deviate from practice that is authorized or required by law. Telepharmacy is a means of providing pharmacy services to patients so as to enhance or expand the services they In addition to the legislative frameworks in place in various receive and to close identified service gaps. Its scope is as jurisdictions, individual healthcare organizations may have broad as the technology can support and legislation allows. specific policies and practices that put constraints on the Circumstances where telepharmacy is used include, but are use of telepharmacy. Relevant organizational or site policies not limited to, delivering services in geographically remote will need to be reviewed, and in some cases modified, areas; covering for absences due to vacation, illness, or before a decision is made to implement telepharmacy vacancy; streamlining operational workflow; and increasing services. A summary checklist of telepharmacy program opportunities for direct patient care. requirements is presented in Appendix A. Telepharmacy services may use an intrasystem model, in which pharmacy resources are shared across multiple 2 Decision to Use Telepharmacy sites within the same healthcare system, or an intersystem The decision to use telepharmacy should be the result of model, in which services are provided through an external collaboration between the organization’s management facility or vendor.2 and pharmacy management. The decision will stem from a desire to improve the quality and safety of patient care by The following are examples of pharmacy services that can closing one or more gaps (real or anticipated) in pharmacy now be delivered using telepharmacy: services or by expanding the provision of direct patient care. a) patient care;2 The following aspects of telepharmacy should be taken into b) medication order entry and verification;2 account to help the organization’s management determine c) medication selection and preparation verification;2 the resources required for implementation: 2 d) drug information service; and a) people; e) staff education sessions. b) policies and procedures; c) physical space; Telepharmacy is one approach to improving the quality d) technology; of patient care. Governments, healthcare leaders, and the public at large have expectations for convenient and e) capacity; and timely access to care, patient safety and improved health f) quality. Canadian Society of Hospital Pharmacists 3 Various analyses (e.g., needs assessment, cost–benefit i) people analysis, risk assessment, and failure mode and effects ii) physical space analysis), as well as determination of the long-term and iii) technology and equipment short-term consequences for the organization, will help to inform the decision. iv) funding; f) economic analyses; The rationale supporting a decision to use telepharmacy g) privacy and security considerations; should be documented and regularly reassessed to ensure h) underlying assumptions; and that goals are being met. i) implementation strategy. For more information about reassessment, refer to section 8: Quality. Ideally, the business case should be developed through consultation with stakeholders (e.g., pharmacy staff, medical 2.1 Legal Authority staff, nursing staff, information technology [IT] department). All pharmacy personnel delivering telepharmacy services shall meet or exceed the comparable standard for in-person 3 People care. All aspects of the use of telepharmacy services shall comply with the relevant federal and provincial/territorial 3.1 Training and Assessment legislation, as well as applicable privacy legislation, codes of All persons involved in telepharmacy services (at both the ethics, standards of practice, and policies and procedures of service provider and recipient sites) shall be trained and the relevant pharmacy regulatory authorities. shall demonstrate competency in the relevant policies and procedures before using telepharmacy services.4 Persons or organizations who provide or receive telepharmacy services should align their practice with the At a minimum, training shall address the following topics: applicable pharmacy regulatory authority requirements for telepharmacy services. The most accountable regulated a) communication;4 pharmacy personnel must be clearly identified and must b) telepharmacy technology,4 including procedures for be accountable to the provincial/territorial pharmacy regulatory authority. Telepharmacy services involving setup, operation, and downtime; additional unregulated pharmacy personnel or other c) service delivery processes and expectations of all staff regulated (non-pharmacy) healthcare professionals involved in telepharmacy; must meet the requirements of the provincial/territorial d) relevant privacy and security issues; and pharmacy regulatory authority, as well as any applicable organizational policies. e) requirements for documentation. If the telepharmacy services are provided by someone Pharmacy management shall ensure that personnel who practises in a provincial or territorial jurisdiction other undergoing training as service providers will work under than the one where the services
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