leading change, critical access hospital pharmacy
TRANSCRIPT
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