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Can Telepharmacy Reduce Rural Critical Access Drug Mistakes? Yes.

Cheryl Clark, for HealthLeaders Media, May 20, 2009

Last year, a Joint Commission review at 15-bed Cross Ridge Community Hospital in Wynne, AR, found unacceptable a practice by which a daytime pharmacist retrospectively reviewed nighttime prescription orders after they were administered.

In St. Louis County, Minnesota, 25-bed Ely-Bloomenson Community Hospital was having trouble recruiting pharmacists because of a requirement they be on call at all times.

At Atoka Memorial Hospital in Oklahoma, officials assumed there were very few medication errors taking place at the 25-bed facility. They soon discovered that was not the case.

And in the Black Hills of South Dakota, 18-bed Lead-Deadwood Regional Hospital had to depend on pharmacy services from 40-bed Spearfish Regional, 15 miles away, a situation that was "untenable as Lead-Deadwood was often dependent on Spearfish's priorities," according to a new report on the use of telepharmacy in rural areas.

These four critical access hospitals in very rural regions of the nation are among some 20 small acute care facilities that are solving their problems with the use of such technologies in an effort to improve the way they dispense medications to their patients. Their situations, and the reasons for executive decisions to transition to remote prescription services, are described in a new report from the Upper Midwest Rural Health Research Center.

The study, "Implementation of Telepharmacy in Rural Hospitals: Potential for Improving Medication Safety" concludes that while such electronic technologies hold high promise for improving quality, very few systems have implemented them in part because of lack of state regulatory guidance or support.

"The use of telepharmacy technology to provide pharmacist services to rural hospitals is not widespread," the report cautioned. Nevertheless, some of the hospitals that have implemented it "have seen improvements in their medication error rates." Additionally, some are tracking whether telepharmacy affects accuracy of order entry, turnaround time, number of after-hours orders, productivity of staff, overrides of automatic dispensing machines and billable revenues.

The lead author, Michelle Casey of the University of Minnesota, defines telepharmacy as the process by which a small rural hospital faxes or otherwise transmits by electronic means a medication order for review by a pharmacist at another hospital. Telepharmacy can involve the use of medication dispensing equipment that is remotely controlled, or long-distance supervision of pharmacy technicians by a pharmacist at another site, perhaps through audio-visual equipment.

For example, a pharmacist service might be shared among hospitals in the same healthcare system, or in different healthcare systems. Or hospitals may join together to contract for telepharmacy services with a commercial telepharmacy company.

Several studies have concluded that such strategies can greatly improve medication safety in rural hospitals. Nationally, there is a growing shortage of pharmacists, but nowhere is that supply as lopsided as it is in remote parts of the country.

Telepharmacy helps resolves the challenge of getting pharmacists to review orders on an as-needed urgent basis when they otherwise would have to drive 45 miles across rugged mountain roads to get to the hospital.

Today, Medicare does not require critical access hospitals to have a minimum level of pharmacy staffing, only to have "pharmaceutical services that meet the needs of the patients" and "a pharmacy directed by a registered pharmacist or a drug storage area under competent supervision," the report said.

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