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 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

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.orgwww.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 vs. Present @ THC PASTPRESENT 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

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