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Economic Feasible Innovations in Rural
Pharmacies
Rhonda Wiering, RN
Patient Care Administrator
April Hanson, Pharm.D.
Tyler Healthcare Center
Objectives
Discuss challenges facing delivery of pharmacy services in rural communities
Discuss issues related to delivery of pharmacy services in Critical Access Hospitals (CAH)
Tyler, Minnesota
Wind Towers of Southwest Minnesota
These wind towers stretch
for miles across the
Buffalo Ridge, near Tyler.
Æbleskiver Days
Tyler's Aebleskiver Days is an annual tradition that promises fun, food, and a great time for the entire family! There are games for the kids, crafts and entertainment for the adults, and of course, good food everywhere, including our famous Danish sandwiches, and the Aebleskiver - a tennis ball shaped Danish pancake.
A Danish Heritage event
Back 2 Back State Champs!!!RTR Knights are the Class A State
Champions for 2004 & 2005!
Tyler Healthcare Center
A.L. Vadheim Hospital
Sunrise Manor Nursing Home
Tyler Medical Clinic
Tyler Home Care & Ridgeview Hospice
Tyler Healthcare Center Timeline
2003: Community identified as at risk of losing lone retail/hospital pharmacist to retirement
Collaborated with U of MN to recruit pharmacy resident
Why Tyler:
Risk of losing lone retail/hospital pharmacist
Administrators open to change Tyler native @ U of MN
Timeline (cont)
2004: Rural Hospital Planning and Transition Grant received
Community-based needs assessment initiated
-surveys and focus groups Pharmacy resident on hospital staff-
July 2004
Timeline (cont.)
2004-2005: Pharmacy services expanded to include direct patient care mgmt at Tyler Medical Clinic
2005: Resident recruited to serve as full-time pharmacist
Pharmacy student training site
Tyler Healthcare Center Demographics
21-bed CAH hospital in Tyler, MN Service area: 30 mile radius of Tyler in
SW MN 20% of patients >65 years old 2 MDs, 1 PA-C
CAH Definition
Medicare program Cost-Based Reimbursement vs. DRG Rural community outside of metro area <25 beds, where <15 are for acute care Average length of stay <96 hours
Pharmacy Services in CAH
Common: pharmacist onsite few hours/day for inpatient dispensing
With new guidelines effective July 1, 2004: More specific about pharmacist role
CAH Guidelines
C-0276
“All prescribers’ medication orders (except in emergency situations) should be reviewed for appropriateness by a pharmacist before the first dose is dispensed.”
Effective July 1, 2004
CAH Guidelines
Pharmacy maintains control over drugs in all locations
Appropriate monitoring of med therapy Compound sterile products
More Reasons for Pharmacist
CAH National Patient Safety Goals: 2005
Professional Satisfaction for HC providers
CAH National Patient Safety Goals 2005
Found at www.jcaho.org1. Improve accuracy of patient identification2. Improve effectiveness of communication among caregivers3.Improve safety of using medications4.Improve safety of using infusion pumps
Patient Safety Goals Cont
5. Reduce risk of health care-associated infections
*6. Accurately and completely reconcile medication across the continuum of care.
7. Reduce risk of patient harm resulting from falls
Medication Reconciliation
By Jan 2006: “develop process for obtaining and documenting a complete list of pt meds with pt involvement”
Accurate medication lists from clinic-hospital-home
Admission medication lists Discharge counseling
Part-time to Full-time Pharmacist
Change for ALL departments esp. nursing
One physician comfortable working with pharmacists- “champion physician”
Nurses used to being the “pharmacist”
Past vs. Present @ THC
PAST PRESENT
▀ Call affiliate w/ med ?
▀ Pharmacy organized as physician ordered “easier to find”
▀ Dispensing via bottles on floor, limited unit-dose
▀ Onsite PharmD to answer ?
▀ Generic organization
▀ Unit dose dispensing
Professional Satisfaction
Nurses decreased time spent dispensing/mixing IVs
Calculating doses Physician interaction/collaboration Implement pharmaceutical care
Pharmacy Involvement
Collaborative practice agreement in anticoagulation
Committees: Medication Errors, P&T, Infection control,CQI, Pain CQI
Implemented unit dose dispensing Nursing education programs Inventory control-preferred PPI and
quinolones Policy/procedure update/implementation
Financial Benefits
Inventory control Collaborative practice agreements Salary reimbursed via CAH
Conclusion
Collaboration with college of pharmacy effective in recruiting pharmacist and identifying pharmacy delivery issues in rural communities
Pharmacist role expanding in CAH Increased job satisfaction for healthcare
providers Full-time pharmacist is justifiable