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