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
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.
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 staffJuly 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.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
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 clinichospital-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 ?
▀ Onsite PharmD to
answer ?
▀ Pharmacy organized
as physician ordered
“easier to find”
▀ Generic organization
▀ Dispensing via bottles
on floor, limited unitdose
▀ 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
