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Economic Feasible Innovations in Rural Pharmacies

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

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Economic Feasible Innovations in Rural Pharmacies

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  1. Economic Feasible Innovations in Rural Pharmacies Rhonda Wiering, RN Patient Care Administrator April Hanson, Pharm.D. Tyler Healthcare Center

  2. Objectives • Discuss challenges facing delivery of pharmacy services in rural communities • Discuss issues related to delivery of pharmacy services in Critical Access Hospitals (CAH)

  3. Tyler, Minnesota

  4. Wind Towers of Southwest Minnesota These wind towers stretch for miles across the Buffalo Ridge, near Tyler.

  5. Æbleskiver Days A Danish Heritage event 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.

  6. Back 2 Back State Champs!!! RTR Knights are the Class A State Champions for 2004 & 2005!

  7. Tyler Healthcare Center • A.L. Vadheim Hospital • Sunrise Manor Nursing Home • Tyler Medical Clinic • Tyler Home Care & Ridgeview Hospice

  8. 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

  9. Why Tyler: • Risk of losing lone retail/hospital pharmacist • Administrators open to change • Tyler native @ U of MN

  10. 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

  11. 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

  12. 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

  13. 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

  14. 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

  15. 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

  16. CAH Guidelines • Pharmacy maintains control over drugs in all locations • Appropriate monitoring of med therapy • Compound sterile products

  17. More Reasons for Pharmacist • CAH National Patient Safety Goals: 2005 • Professional Satisfaction for HC providers

  18. CAH National Patient Safety Goals 2005 • Found at www.jcaho.org 1. Improve accuracy of patient identification 2. Improve effectiveness of communication among caregivers 3.Improve safety of using medications 4.Improve safety of using infusion pumps

  19. 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

  20. 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

  21. 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”

  22. PAST PRESENT Past vs. Present @ THC • Onsite PharmD to answer ? • Call affiliate w/ med ? • Pharmacy organized as physician ordered “easier to find” • Generic organization • Dispensing via bottles on floor, limited unit-dose • Unit dose dispensing

  23. Professional Satisfaction • Nurses decreased time spent dispensing/mixing IVs • Calculating doses • Physician interaction/collaboration • Implement pharmaceutical care

  24. 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

  25. Financial Benefits • Inventory control • Collaborative practice agreements • Salary reimbursed via CAH

  26. 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

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