$1 million for pharmacist shortage

BY GAZETTE STAFF
The Southern Gazette

Eastern Health has announced it will offer pharmacists a temporary $12,000 market differential allowance. It’s an effort to address the pharmacist shortage and an increasing vacancy rate.

The total cost of the additional allowance will reach approximately $1 million.

The health authority also plans to make new organizational investments in recruitment and professional development.

President and Chief Executive Officer George Tilley admitted "this has been a challenging period for Eastern Health.

"We hope this interim measure will stabilize our service by retaining our current pharmacists and assist us in attracting pharmacists to our organization so we can refocus on meeting the needs throughout the region, especially in clinical pharmacy services."

The market differential allowance is for the life of the current collective agreement and will be paid out semi-annually with a return in service agreement signed prior to payment.

Mr. Tilley indicated although Eastern Health had hoped the government would be in a position to work through this issue provincially, "we appreciate the government’s need to deal with this through the collective bargaining process and have decided to deal with this internally."

He agreed pharmacists are integral to the provision of care in the region. Eastern Health’s priority is to ensure the needs of patients, clients and residents are met and to make sure pharmacists, and other care providers, are able to work effectively to meet the needs of individuals the organization serves.

Eastern Health will continue to work within the contingency plans currently in place and monitor the situation closely.

Source

State faces shortage of pharmacists

With an aging population and longer life spans, Wisconsin hospitals are facing shortages of pharmacists, physical therapists, radiologic technologies, physicians and registered nurses.
Those are the five most difficult positions to fill in health care, according to a new report by the Wisconsin Hospital Association (WHA).
A sharp increase in the utilization of prescription drugs and more pharmacists retiring than joining the field are fueling a severe shortage of pharmacists in the state, the report stated. The WHA cited a soaring demand for pharmacists in retail outlets and the fact that utilization of prescription drugs increased 71 percent from 1994-2005.
"In Wisconsin, hospitals are reporting that finding a pharmacist is their most challenging recruitment issue, a problem that will not be solved without increasing the number of pharmacists graduated in Wisconsin. Admissions to Wisconsin's only pharmacy school have remained flat since 2001, a situation that is forcing Wisconsin hospitals to spend up to a year recruiting nationwide for out-of-state graduates to meet the growing demand for pharmacists," the report stated.
"Many hospitals employ a relatively small number of pharmacists, so even a single vacancy can create a crisis in coverage. As key members of the patient care team in hospitals, a vacancy can mean limiting hours of access or delays in obtaining medications," according to Judy Warmuth, WHA's vice president of workforce and the author of the report.
With fewer students choosing nursing, graduation rates were not keeping pace with hospitals' need for nurses, the WHA reported. While nursing school enrollments have risen dramatically, the number of graduates has grown more slowly for two reasons: it is taking students longer to graduate; and some students who enter a program fail to complete it.
"The average nurse working in a Wisconsin hospital is 47 years old. We need to prepare for the fact that soon we could see a large number of nurses retire at about the same time. The nursing schools have done an extraordinary job expanding their programs and promoting nursing as a career that should help avert a nursing shortage crisis similar to those that are already hitting other parts of the country," said Warmuth. "For now, we can say our nursing vacancy rates are low in Wisconsin, but we certainly can't say we won't see shortages in the near future."
The state also has acute shortages of physicians in rural and inner city hospitals, according to the report.
The full WHA report can be found at www.wha.org/workForce/pdf/2006workforce_october.pdf.

Source

Renville pharmacy to join drugstore chain

Tom Cherveny
West Central Tribune - 11/29/2006

RENVILLE — A Renville pharmacist who fought for federal legislative reforms to protect independent, rural pharmacists has reached an agreement to sell her business.

“I just can’t do it anymore,’’ said Leah Seehusen, owner of Leah’s Pharmacy in downtown Renville. She said the frustrations of dealing with private insurance and Medicare reimbursement systems that work against independent, rural pharmacists proved “overwhelming.”

Thrifty White Drug, a Maple Grove-based drugstore chain, will purchase Seehusen’s pharmacy and store on Dec. 20, according to an agreement she reached with the company.

In what may be a sign of things to come, Thrifty White Drug has obtained state permission to open a telepharmacy operation in the store to replace Seehusen, a registered pharmacist.

Two technicians will continue to staff the in-store pharmacy. Prescriptions will be reviewed by a pharmacist at a remote site. A satellite link will be used, Seehusen said.

A similar model has been working in North Dakota at a number of rural pharmacies since 2003. Minnesota has also allowed Thrifty White to implement the system at some of its Minnesota stores.

Seehusen said the acquisition by Thrifty White Drug and the introduction of telepharmacy will mean that Renville area residents can continue to obtain pharmacy services in their hometown. It also means that the store will remain a part of the community’s business sector. All of its employees have been offered opportunities to continue in their jobs, she added.

Seehusen has owned and operated the store for more than 13 years. A graduate of the Olivia High School, Seehusen said she had wanted to own a business in a rural community even before she wanted to be a pharmacist.

Her dream soured in recent years. Seehusen said that the new Medicare Part D program and private insurance providers have continued to squeeze rural pharmacists. Rural pharmacists realize as little as $1 to $2 reimbursement for many of the prescriptions they fill, she said.

Rural pharmacists are not able to make up for the small margins with a greater volume of sales, she said.

At the same time, the job of a rural pharmacist has become much more demanding. Provider contracts and regulatory changes have imposed multiple layers of paperwork and added responsibilities, Seehusen said.

She brought her case to U.S. Sen. Norm Coleman, R-Minn. She said the senator was sympathetic to the plight of rural pharmacists, but things have not improved. The new Medicaid Part D program is worse for pharmacists, she said. She charges that more of the revenue is being siphoned to third-party pharmacy benefit managers, and not the pharmacists who actually serve consumers.

Seehusen said she does not expect change until consumers become mad enough to demand change.

With the sale of her store, Seehusen will become an employee of Thrifty White Drug and serve as a relief pharmacist for its stores in the area.

Her longer-term plans call for exploring her options and possibly moving her family to a new location. A wife and mother of two children, ages 10 and 6, Seehusen said the demands of running a rural pharmacy interfered greatly with family life. “There’s more to life than working this hard,’’ she said.

Source

Patient safety in question

Pharmacist shortage reaching crisis levels

KIRK SQUIRES
The Packet

It’s affecting the lives of hospital pharmacists and it could have serious implications for hospital patients in this province.

There is a shortage of pharmacists across Canada but it’s particularly bad here.

It’s a situation the Pharmacists’ Association of Newfoundland and Labrador (PANL) says is not being addressed by government.

In fact PANL, in a recent release, says, "Government is being penny wise and pound foolish in its decision not to address the pharmacist shortage in the public sector."

The shortage is about to cause a potentially dangerous situation at the G.B. Cross Memorial Hospital in Clarenville.

That facility has one full-time pharmacist on staff, Bernadine Barrett. Another is scheduled to return to work today. But the facility should have three.

This summer one of the three pharmacists left the area, leaving just two to carry the workload and fill the on-call responsibilities.

Barrett says the situation caused a great deal of stress and concern.

In an effort to raise public awareness of the situation, and the implications this shortage could have on patent safety and care, Barrett forwarded a letter to VOCM’s Open Line.

At that time the two pharmacists had been working with a shortage for approximately six weeks with no end in sight.

"The extra demands and responsibilities that we now deal with have forced us to work at a much faster pace . . . and, quite frankly, a much faster pace than I am comfortable with."

With an increase in workload Barrett says the chances of a medication error also increase.

Due to the increase in workload the pharmacy had to be closed on weekends. Instead of a pharmacist working in the pharmacy from 8:30 a.m. to 4:30 p.m. on Saturday and Sunday, the two shared 24-hour on call duties.

Being on 24-hour call created stress for Barrett. When her husband was working it was impossible to find a sitter, for their young child, at a moment’s notice..

Aside from family concerns she was greatly concerned for patient safety.

"Prescriptions that are written between 4:30 p.m. on Friday to 8:30 a.m. Monday morning are not checked by a pharmacist. If an error should occur on Friday evening it could continue for the entire weekend and might not be picked up. Because we are so busy it is hard to pick up on mistakes at this point," she says.

"Ensuring safe medication use is a primary function of every pharmacist. Unfortunately, the safeguard that we provide against medication error is no longer available throughout the weekend at our hospital," Barrett writes in her Sept. 22 letter.

With the heavier reliance of the health care system on medications, and more types of medications being used, the danger of serious interaction between certain drugs is increasing. That is one reason why pharmacists are an integral part of the health care team.

"That is why we exist, that’s what we do. We as pharmacists can identify interactions and know the most serious interactions to look for."



Bad to worse

The concerns of PANL, Barrett and other pharmacists haven’t done much to alleviate the situation or get action from government.

In fact, the situation at G.B. Cross went from bad to worse about four weeks ago when another pharmacist at the hospital went off on extended leave.

"That basically left me as the only full-time pharmacist at G.B. Cross. I have been lucky up to now to have a relief pharmacist to fill in," explains Barrett.

In an Oct. 17 letter to Liberal Health Critic, MHA Yvonne Jones, Barrett outlined the extent of the increased workload she is expected to deal with on a regular basis.

For example on an average workday a single pharmacist would normally be responsible for 100-150 prescriptions. On Thanksgiving Monday Barrett filled 331 prescriptions.

That does not include other responsibilities such as meeting with patients to go over their medication before they are released or if special cases come into the hospital that need attention.

In her letter to Jones, Barrett also notes the best hope for another pharmacist for G.B. Cross is July, 2007, when a new crop graduates from Memorial University’s School of Pharmacy.

However, those that do decide to stay in this province will likely be lured by the more attractive pay scale in the retail sector.

PANL executive director George Skinner says it has created a lot of stress among pharmacists working in the public sector.

"It is very stressful. I have talked to members across the province and they are basically at their wits end as to what to do. They have high demands and there doesn’t seem to be any resolution forthcoming. What concerns the association so much is we thought for a while government had heard the problem and was going to take some creative approach to solve it."



Facts and figures

Earlier this year, PANL established an ad hoc Hospital Steering Committee on Labour Market to review the situation.

The result was the 2006 Report on Critical Hospital Pharmacists Shortage in Newfoundland and Labrador.

The report outlines the important role pharmacists play in the health care system "Providing comprehensive drug management to hospitalized patients, physicians and other members of the multi-disciplinary health care team."

The report also notes as of March, 2006, the Regional Integrated Health Authorities in Newfoundland and Labrador had 19 vacancies. According to a Nov. 17 release from PANL, that number now stands at 25 vacancies.

Two of those positions, in St. Anthony, have been vacant for two years. As a result the Newfoundland and Labrador Pharmacy Board has not renewed that hospital’s pharmacy license.

The report goes on to state, "The loss of highly qualified, experienced pharmacists has been crippling the health care system and associated pharmacy services."

All the regional health authorities have advertised for pharmacists in local and national newspapers and recruitment fairs. At the time the report was released there was zero success in recruiting.

What’s worse the situation is not likely to change any time soon.

"In the last two years, only one new graduate has taken a position with the public health care system in this province," the report notes.



Government responsibility

What’s the solution?

Skinner says it’s not rocket science. All government has to do, he says, is carry out a Labour Market adjustment like the other three Atlantic provinces have already done. That adjustment was also noted in the Department of Health and Community Services human resources report in 2003.

"You can’t debate the facts and the fact is the other three Atlantic provinces . . . their governments have had to take action to remedy it and, for some reason, our government has chosen not to.

"You have some of our youngest, brightest Newfoundlanders being forced to leave the province for all kinds of very legitimate reasons when we could be doing something to keep them here," adds Skinner.

Even those pharmacists who do decide to stay in the province are not looking to the public sector.

"They don’t have to go across the Gulf, they can go across the street (to retail). That’s why PANL has asked for a Labour Market adjustment."



Money not the issue

But money is not the issue for pharmacists like Barrett.

In her letter of resignation she says, "Five years ago, I decided to accept this position for two reason; the opportunity to do clinical work and because I thought it would be the best place for me to continue my professional career and start a family. The events of the past three months have made participation in any type of clinical practice all but impossible."

It was a tough decision for Barrett.

In an emotional interview with the Packet Barrett says she feels she was forced to make this decision. She says the main reason for her decision to resign was her family.

"Due to the increase in on-call responsibilities and workload that have been imposed on me, as well as the high probability that circumstances within the pharmacy will worsen in the very near future, I feel I have been forced to make a choice between my family and my job," writes Barrett in her letter.

"I have chosen my family."

Source

SU’s prescription for success

Pharmacy program has become a model for other schools

By Sarah A. Reid
The Winchester Star

---

WINCHESTER — On Monday, Alan B. McKay was talking with a delegation from Husson College in Maine — the third set of school representatives to come through his doors in the past month.

“Maine is one of the states that doesn’t have a pharmacy school,” said McKay, the dean of Shenandoah University’s Bernard J. Dunn School of Pharmacy.

Alan B. McKay, the dean of the Shenandoah University Bernard J. Dunn School of Pharmacy, said, “We are not going to have enough pharmacists — period.” (Photo by Jeff Taylor)

As more and more colleges around the country explore the idea of adding pharmacy courses, SU has become a destination for some educators learning how to set up their program.

“It is happening all around us,” McKay said.

It’s happening so close, in fact, that Radford University, a public college in the New River Valley, is considering the establishment of a pharmacy school.

“We are in the very early stages of concept development and analysis,” said Rob Tucker, the director of university relations at Radford. “It’s just an idea we have had. We are exploring it.”

College President Penelope W. Kyle and Randal J. Kirk, the rector of the university’s Board of Visitors, visited Shenandoah’s pharmacy school this month.

Officials with the Winchester-based private school aren’t worried about competition, it seems.

“It is very difficult to start a pharmacy school today,” SU President James A. Davis said, adding that the university could become a partner with Radford. “There are several, perhaps a dozen or more, under consideration.”

When Shenandoah established its pharmacy school in 1995, it was one of 75, McKay said. Now, the American Association of Colleges of Pharmacy is projecting 100 new pharmacy programs will be started by Jan. 1, adding to the 92 in existence.

“So you can see how fast they are ramping up,” McKay said, noting about 32 applications in various states are pending.

But those new schools — which normally take two years to set up — won’t produce enough graduates to stem the growing shortage of pharmacists.

According to the American Association of Colleges of Pharmacy, 41 percent of male pharmacists and 10 percent of female pharmacists are 55 or older and nearing retirement.

“We are not going to have enough pharmacists — period,” McKay said. “It doesn’t matter if we have these schools online. It takes eight years for us to make an impact.”

SU gets about 14 applications for every seat it has open in its 75-student pharmacy program, McKay said.

Two years ago, the school expanded by becoming a partner with George Washington University to create a satellite campus in Ashburn, near the Howard Hughes Medical Institute.

Twenty students are studying pharmacogenomics — or how people respond to specific drugs based on their genetic makeup. The program is set to expand to a 35-student course.

With the “garden variety Wal-Mart pharmacist” starting at $113,000, plus a $13,000 signing bonus straight out of a six-year doctoral program, and with pharmacogenomics majors making 20 to 25 percent more than that, McKay said he’s not worried about other Virginia pharmacy programs taking his students.

“We aren’t concerned about what happens in Virginia,” he said of new pharmacy schools setting up.

What he does watch are schools established in other states or in Canada — the sources of 75 percent of Shenandoah’s pharmacy students.

SU is working with area high schools to try to set up a dual enrollment program where its faculty members could go into public school classrooms — helping systems that have trouble recruiting science teachers and creating more pharmacists faster.

“There are a lot of things on the drawing board we haven’t had time to pursue,” McKay said.

Like Shenandoah’s president, the dean of the pharmacy school also knows that it’s difficult for a new program to get set up.

Faculty members can often make more money working in the private sector, and new programs can sometimes offer more money.

Educators also expect the Accreditation Council of Pharmacy Education to strengthen the regulation of clinical sites, which will make it harder for students from out of state to obtain clinical experience outside Virginia.

“If we can’t guarantee they are quality sites — we can’t use them ...,” McKay said. “Which means we are going to have to start drawing our students closer to us.”

And if new schools are opened, that could mean more competition for hospitals, pharmacies, and ambulatory care facilities that will allow students to get hands-on experience.

— Contact Sarah A. Reid at
sreid@winchesterstar.com

Source

Residents' fears over pharmacy shortage

14 November 2006 | 07:52

CONCERNED residents in a rural Suffolk town have been unable to access prescriptions due to staff shortages at their local chemist.

Customers of the Lloyds Pharmacy in Leiston have been left frustrated on a number of occasions when there has been no pharmacist on duty at the High Street shop.

As a result, the elderly and sick have had to travel to Aldeburgh, Woodbridge, Saxmundham or even Ipswich to get their medication.

Sandra Mackissack, of Eastward Ho, Leiston, said: “There's been no pharmacist there and a relative of mine had to go to Ipswich because she couldn't get her son's inhaler.

“With different bugs going around at this time of year it's diabolical and it's the elderly and the children I feel for.”

She added: “One of these days someone's going to need medication from there in an emergency and a car trip isn't going to be quick enough.”

Mrs Mackissack said there was no pattern as to when the pharmacist is not there to dispense medication.

She said: “There's no warning and you go in and you just get told that you can't have your prescription because there's no-one there who is qualified to dispense it.”

The matter has been raised with Leiston Town Council, which is planning to contact the company to find a resolution to the problem.

Cllr Colin Ginger said: “It's causing a lot of frustration and confusion and it's hard for old people to go out to other towns if they are frail.

“I don't know why it's happening but we are talking about making arrangements and putting notices on doors because there's been no pre-warning.”

He said it was also a concern because the chemist works in conjunction with Leiston Surgery where the pharmacy picks up repeat prescriptions for customers but they cannot retrieve their medication if the pharmacist is not on duty.

David Dufty, east Suffolk spokesperson for Patient and Public Involvement in Health Forum, said: “It's a very serious loss of service and it's up to Lloyds to find a pharmacist as soon as possible.”

Nick Mortimer, superintendent pharmacist for Lloyds, said: “We would like to apologise for the problems experienced recently at our pharmacy in Leiston, which have arisen because of staff sickness and the difficulties of finding a replacement pharmacist at short notice in such a rural location.

“We are very aware of the issue and are working hard to resolve it.”

kate.scotter@eadt.co.uk

Source

Telepharmacy Project Aids North Dakota's Rural Communities

BETHESDA, MD, 18 September 2006 — In 2000, North Dakota found itself in the midst of a pharmacy services crisis. The national pharmacist shortage had hit the mostly rural state particularly hard, said Howard C. Anderson Jr., executive director of the North Dakota Board of Pharmacy.

Newly graduated pharmacists were being lured to larger cities in other states where community pharmacy chains were offering big salaries and other incentives, leaving few pharmacists to take the place of those who were retiring in small, rural communities, Anderson lamented.

More than 25 rural community pharmacies in the state had recently closed, and 12 more were on the verge of shutting their doors.

North Dakota's rural hospitals, many of which had only one pharmacist or relied on contracted pharmacists who worked part-time at the facilities to keep inpatient pharmacies operating, were also challenged by the pharmacist shortage, Anderson said.

After contemplating several options, he said, the board decided to explore telepharmacy as a potential solution to address the predicament.

The North Dakota board spent the next several months reviewing various telepharmacy proposals and models, Anderson said, and worked on developing new rules and regulations that would support implementation of the practice, meet federal requirements and national accreditation standards, and ensure patient safety.

The College of Pharmacy at North Dakota State University (NDSU) soon joined the effort and applied for and received a federal grant from the Health Resources and Services Administration (HRSA) Office for the Advancement of Telehealth to pilot telepharmacy in the state.

North Dakota's telepharmacy project, which recently started its fifth year of the HRSA grant, first tested its model in 2001 at four "central" community pharmacy sites and six remote sites, said Charles D. Peterson, dean of NDSU's College of Pharmacy at Fargo.

The project now has 57 participating sites, which includes 44 community pharmacies and 13 hospitals, he added.

"We are serving in excess of 40,000 rural citizens who previously did not have access to traditional pharmacy services that now have their pharmacy services restored," Peterson said. "These are communities that either lost their services, never had services, or were about to lose services because a pharmacist was about to retire."

The project has added $12.5 million to the economies of small towns in North Dakota by adding new jobs and restoring pharmacy services, he said.

For the project, a pharmacist at a central pharmacy site supervises a registered pharmacy technician at a remote telepharmacy site through the use of audio–video Internet conferencing equipment and digital imaging cameras, Peterson explained.

The pharmacy technician at the remote site prepares the prescription drug for dispensing, including entering the prescription and patient information into the pharmacy system, preparing the container label, and filling the medication vial. The pharmacist communicates to the technician and verifies the technician's work in real time over a secure Internet connection using the audio–video equipment.

The HRSA grant, said Ann Rathke, coordinator of the North Dakota telepharmacy project, covered 50% of the costs of audio–video teleconferencing equipment and installation for each telepharmacy site. The grant also covered the first year of Internet connectivity for each site, she added.

For telepharmacy remote sites that previously did not have a pharmacy technician, the grant paid the salary for a new technician for one year, Rathke said.

North Dakota's project is using Polycom VSX 7000 audio–video equipment, Peterson noted. Most of the sites have digital subscriber lines, or DSL, Internet connections, but some rely on T-1 lines. The connections must be protected with a firewall to ensure compliance with patient privacy laws.

The technician also sends digital images over secure Internet links of the prescriber's script, the medication's original manufacturer container, the prepared label, and a tablet or capsule, if appropriate.

The use of the digital images, Peterson said, helps validate that the patient is receiving the correct medication at the correct dosage. The digital photos can also be stored for later recall if necessary, he added.

Once the pharmacist has completed the final check of the prepared prescription, the pharmacist gives the approval to the technician to release the medication to the patient care area.

Safety concerns. Some people have expressed "high anxieties" that it appears that it is pharmacy technicians and not pharmacists who are dispensing medications at the telepharmacy remote sites, Peterson said.

But, he contended, although the pharmacist is checking the technician's work long-distance rather than within the walls of the pharmacy, it is the pharmacist at the central site who officially dispenses the medication to the patient and is held accountable for the remote site's activities.

Pharmacy technicians working at remote sites must be registered with the state board and be a graduate of a training program accredited by the American Society of Health-System Pharmacists, Peterson noted.

The technician must also have at least one year of work experience before practicing at a remote site, he added.

Peterson asserted that North Dakota's telepharmacy model is actually safer than when a pharmacist in the central pharmacy at a large hospital releases a medication from an automated dispensing machine because many of those systems do not have the audio–video connection that allows for conversation between the pharmacist and the nurse or pharmacy technician at the patient care unit.

"And we think that's problematic," he said. "Part of the feature of the North Dakota telepharmacy model is to keep the pharmacist in the health care loop in providing professional expertise, counsel, and guidance related to proper drug selection and monitoring. And that requires a verbal conversation."

Affordable. The board had considered using automated dispensing systems for its telepharmacy model, Anderson said, but decided that the cost of the equipment was too great for North Dakota's rural community and hospital pharmacies to afford.

A remote pharmacy site can install the audio–video equipment and digital imaging cameras for about a tenth of the cost of an automated dispensing system, Peterson said.

He argued that North Dakota's telepharmacy project provides another patient safety feature that goes beyond the average pharmacy practice: While pharmacies are required to offer pharmacist-provided counseling, which the patient can turn down, patients cannot leave the telepharmacy remote site with a prescription medication until the person receives counseling by the pharmacist over the audio–video connection.

Hospitals participating in North Dakota's telepharmacy project are exempt from the pharmacist-provided counseling requirement, noted John S. Skwiera, pharmacy director at Heart of America Medical Center in Rugby, a rural town near the Canadian border.

Hospital telepharmacy networking. As part of North Dakota's project, Skwiera's inpatient pharmacy has formed a telepharmacy network with six other rural hospital inpatient pharmacies in Devils Lake, Cando, Harvey, Rolla, Carrington, and Mandan to help provide vacation, after-hours, weekend, and emergency pharmacist coverage. Each of the network's seven participating hospitals currently has only one pharmacist, he noted.

The facilities, Skwiera said, have "literally crossed across corporate barriers" to provide relief coverage for each other using North Dakota's telepharmacy model.

Three of the facilities joined the telepharmacy project last year, and the other four joined this year, he noted.

All of the facilities have the Polycom audio–video systems and digital imaging equipment installed in their pharmacies.

The seven pharmacists also have the equipment installed in their homes so that they can communicate with hospital technicians after hours or when inclement weather strikes and the pharmacist is unable to make it to the hospital.

"They are able to work from home as long as there is a technician onsite," Skwiera said.

The seven facilities have experienced only minor "speed bumps in the road" with the teleconferencing and digital imaging equipment, Skwiera said. Most of the problems have revolved around Internet connectivity issues, he said.

One telepharmacy site in particular, he noted, has had trouble with its system "freezing up" when transporting digital images.

The Internet connectivity at some of the pharmacists' homes has also been somewhat problematic, Skwiera said.

"Certainly, trying to connect everyone in a safe and secure network has been challenging, and I don't think we've quite reached that point where we're completely happy with it, but we are moving toward that," he said.

Pharmacists participating in the network arrange coverage with another pharmacist several weeks in advance when possible, Skwiera said. But, he said, because there are only seven pharmacists, the scheduling process is "mostly informal," especially when pharmacists are ill or need to leave town suddenly.

Some relief. The telepharmacy network, which Skwiera describes as a team, has helped to keep participating pharmacists "contented in their jobs."

"The Achilles' heels in these rural areas is that the hospital pharmacist has a ball and chain to their leg, and they don't feel like they can leave their work," Peterson said.

By participating in the telepharmacy network, he said, the pharmacists can feel more relieved about taking a vacation or calling in sick.

Peterson noted that Colorado-based Catholic Health Initiatives is creating a regional office in Fargo to establish a hospital telepharmacy network of its own in the state.

Following policies. Skwiera said that because the hospitals participating in the telepharmacy network came from a "broad spectrum of institutions," the facilities developed a joint policy agreement to ensure that patient care issues were addressed and that each hospital's policies were properly followed by all participating pharmacists and technicians.

Some of the seven hospitals participating in the telepharmacy network are accredited by the Joint Commission on Accreditation of Healthcare Organizations, and some are not, Skwiera said.

"Certainly, we have to be aware that we really can't supersede or change the policies of another hospital that we're doing telepharmacy with," he said. "We have to make sure that we practice accordingly so that we provide the quality of care necessary within the parameters of each institution's policies."

The networks have filed their joint telepharmacy policy agreement with the board of pharmacy for its review, Skwiera noted.

To date, he said, no patient safety issues related to the telepharmacy practice at each site have arisen. He attributed much of that success to the board of pharmacy ensuring that participating technicians are competently trained.

"None of this works without really good people that you trust at each site," Skwiera said.

—Donna Young

Source, Mirror

Other articles by AJHP about Telepharmacy