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Virtually none of the more than 1,000 rural critical access hospitals (CAHs) in rural America can afford a round-the-clock R.Ph. on staff. And this lack of coverage can adversely affect quality by slowing the prescription review process, said Tim Stratton, R.Ph., Ph.D., an associate professor at the University of Minnesota College of Pharmacy in Duluth.
The Institute of Medicine sees a link between medication safety and understaffing at small rural hospitals. JCAHO (Joint Commission on Accreditation of Healthcare Organizations) standards for CAHs also address the issue. "All the CAHs in northeast Minnesota lack 24/7 coverage, and relief pharmacists are unavailable," Stratton said. But fully staffed urban facilities can help smaller facilities by means of telepharmacy, he told fellow pharmacists at the ASHP meeting in Las Vegas in December.
Stratton described the problems and promise of rural telepharmacy as experienced in a health information technology demonstration project sponsored by the federal Agency for Healthcare Research & Quality (AHRQ). "The problem is, How can round-the-clock access to pharmacist expertise be provided at small hospitals in geographically remote communities without burning out the pharmacist?" Stratton asked attendees at a session titled "Small and Rural Hospitals: Unique Innovations for Unique Challenges."
From a patient's perspective, this makes a lot of sense, said Keith Pearson, R.Ph., director of pharmacy at Bigfork Valley Hospital in Bigfork, Minn. "It's better to have a medication order reviewed before administration than after. We'd like a pharmacist on site 24 hours a day, but that's not going to happen any time soon."
To address this concern, SISU Medical Systems, a consortium of medical centers in northeastern Minnesota, collaborated in 2003 with St. Luke's Hospital in Duluth and the College of Pharmacy at the University of Minnesota to seek AHRQ funding. The group was awarded $3.15 million to cover three years-October 2004 to September 2007.
Seven rural hospitals participate. Others, such as Falls Memorial in International Falls, Minn., would like to join if they could. Said Dick Peterson, R.Ph., director of pharmacy at Falls Memorial, "Right now we don't have the right software to be involved, but if we could make that happen, we'd sign on immediately."
"A project like this is not cheap, so funding continues to be a critical issue," said Stratton. In addition to the AHRQ grant, the project is supported by flat fees charged to participants. About 80% of the money is used to pay for a pharmacist at the hub hospital (St. Luke's). The remaining funding is used to purchase and install the required technology.
Participants use Meditech software to communicate. When a pharmacist is not on duty at a rural hospital, an Rx is faxed to the hub hospital with 24-hour coverage. "An entire medical record can be downloaded and reviewed over the Internet," said Stratton, "making the necessary information available to compose an order." After the review, the R.Ph. at the hub hospital has a technician transmit approval back to the rural facility. If the facility uses an automated dispensing cabinet, medication is released. Otherwise, dispensing and administration instructions are transmitted.