Leading Change, Critical Access Hospital Pharmacy ...

Leading Change, Critical Access Hospital

Pharmacy Residency Project

Rhonda Wiering, RNPatient Care Coordinator, Tyler Healthcare Center

Todd D. Sorensen, Pharm.D.Associate Professor, University of Minnesota

Tyler, Minnesota

Wind Towers of Southwest Minnesota

These wind towers stretch

for miles across the

Buffalo Ridge, near Tyler.

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

Back 2 Back State Champs!!!RTR Knights are the Class A State

Champions for 2004 & 2005!

Tyler Healthcare Center

A.L. Vadheim HospitalSunrise Manor Nursing HomeTyler Medical ClinicTyler Home Care & Ridgeview Hospice

Tyler Healthcare Center Demographics

21-bed CAH hospital in Tyler, MNService area: 30 mile radius of Tyler in SW MN20% of patients >65 years oldNursing home, hospice/home health services 2 MDs, 1 PA-C

CAH Definition

Medicare programCost-Based Reimbursement vs. DRGRural community outside of metro area<25 beds, where <15 are for acute careAverage length of stay <96 hours

Pharmacy Services in CAH prior to Pharmacy Project

Local Pharmacist onsite ½-2 hours/day for hospital inpatient dispensing. Nursing department responsible for inventory management/ ordering. Primary pharmacy function was dispensing and managing controlled drugs. Used all manual functions including limited use of unit dose packaging. 2003: Community identified as at risk of losing lone retail/hospital pharmacist to retirement.

Pharmacy Project Need

CAH Rules-C-0276-Effective July 1, 2004“All prescribers’ medication orders (except in emergency situations) should be reviewed for appropriateness by a pharmacist before the first dose is dispensed.”Pharmacy maintains control over drugs in all locationsAppropriate monitoring of med therapyCompound sterile products

More Reasons for Pharmacy Project

CAH National Patient Safety Goals: 2005Healthy People 2010Professional Satisfaction for HC providers

A Tool for Practice Development: Pharmacy Residency Education

Prepare pharmacists for patient-centered practice.Influence the practice of pharmacy in Minnesota…and beyond.Facilitate the growth of “model” advanced practice sites for the College of Pharmacy.

A Foundation for Partnerships…

College of Pharmacy– Framework for residency

education/accreditation– Expertise in practice

development– Administrative support– Comprehensive,

coordinated marketing effort

– Assist in acquiring seed money

Practice Sites– Patients who have a

need for pharmaceutical care

– Enthusiasm for practice development

– Funding for residents– Commitment to teaching

residents AND students– Serve as a model for

additional opportunities for collaboration

Program Emphasis

Program focus is ambulatory careUrban and Rural PartnersThree unique areas of emphasis – Community Health– Rural Health– Professional Leadership

Our Partners - 2005

Community Health– UMP, Fairview, Westside CHC, St. Cloud VAMC

Rural Health– Tyler HC Center, Paynesville Area HCS, St.

Elizabeth’s Hospital/Mayo Clinic (Wabasha)Professional Leadership– UM COP, UMP, Fremont CHC

Outcomes of Collaboration

Addressing community/organization specific problemsCreating a broader view of the role of pharmacy in an organization– Expansion of the role of pharmacists

Increased availability of pharmacists with advanced trainingAllowing for “win-win” between UM and health care organizations

Pharmacy Project

2004: Rural Hospital Planning and Transition Grant receivedCommunity-based needs assessment initiatedPharmacy resident on hospital staff-July 2004

First Year Pharmacy Project Activities

Collaborative practice agreement in anticoagulationCommittees: Medication Errors, P&T, Infection control,CQI, Pain CQIImplemented unit dose dispensingNursing education programsInventory control-preferred PPI and quinolonesPolicy/procedure update/implementation

Results2004-2005: Pharmacy services expanded to include direct patient care mgmt at Tyler Medical Clinic2005: Resident recruited to serve as full-time pharmacistResident pharmacy program continuesAwarded Capital Improvement Grant to purchase Pyxis or other automated computer dispensing system to begin in June, 05.

Professional Satisfaction and Financial Benefits

Nurses decreased time spent dispensing/mixing IVsDr. interaction/collaborationImplement pharmaceutical careInventory controlCollaborative practice agreements

CAH National Patient Safety Goals 2005

Medication related to 5 of 7 goalsMedication specific:-Improve the safety of using medications.-Accurately and completely reconcile medications across the continuum of care.

Source: www.jacho.org

Healthy People 2010

Objective 17: Medical Product Safety-Increase proportion of people who review with patients >65yo all new or OTC meds-Increase proportion of patients who receive verbal counseling