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Telepharmacy Helps Rural Hospital Cope With Pharmacist Shortage

Kate Traynor

A telepharmacy project is bringing the benefit of hospital pharmacist support to Othello Community Hospital in rural Washington.

"We haven't had a full-time pharmacist here for quite a while," said Jody Ulrich, director of nursing services at 32-bed Othello. "Rural hospitals have a hard time keeping a pharmacist."

Through the pilot telepharmacy project, nurses at Othello can communicate with pharmacists at Sacred Heart Medical Center in Spokane, about 110 miles northeast of Othello.

"Here in Spokane," said Larry G. Bettesworth, Pharm.D., director of pharmacy at Sacred Heart, "we actually have secure access into [Othello's] pharmacy system."

At Othello, specially trained nurses enter medication orders into the pharmacy computer and then fax a copy of the original orders to Sacred Heart for review by a pharmacist.

Bettesworth said that Othello's nurses learned to enter orders by following the "tech-check-tech" procedures approved by the Washington State Board of Pharmacy.

"The nurse has to be 99 percent accurate in order-entry skills," Bettesworth said, adding that the nurses involved in the project "do a very excellent job."

Bettesworth said that, after his pharmacy receives a medication order from Othello, a pharmacist looks over the order and performs the customary review. After the pharmacist indicates approval of the order in the computer, a nurse at Othello retrieves the medication from the hospital's automated dispensing machine.

In addition to the pharmacy computer network, the hospitals share a videoconferencing system that allows a pharmacist and a nurse to communicate face-to-face if a problem occurs with a medication order.

"We can see them up on the screen," Ulrich said. "It works really great. You can put a face to who you're talking to."

Before the pilot program began, Ulrich said, medication orders at Othello were reviewed by a community pharmacist who worked there part time. Othello still relies on a part-time pharmacist to stock the automated dispensing machines, she added.

Ulrich said the nurses have been very pleased that they can communicate with pharmacists who understand intravenous drugs and other medication-use issues that hospitals face.

"We have retail pharmacists, but hospitals need hospital pharmacists," she said. "My goal one day would be to see [telepharmacy] in place at a lot of small, rural hospitals that cannot get a hospital pharmacist and that rely on a retail pharmacist who comes in one or two days a week."

"I think this program is fairly unique," said Bettesworth, noting that most telepharmacy projects involve clinics or community pharmacies. "I'm not aware of any programs out there that really support rural hospitals," he said.

Ulrich said that, except for "a couple of bugs with the faxing that we had to work out the first week," the telepharmacy project has been a success. "It's been great having a hospital pharmacist available," she said.

Bettesworth said that the pilot project, which has been running for nearly six weeks, is likely to expand soon. Besides Othello, he said, about six other rural hospitals are interested in Sacred Heart's telepharmacy service. These hospitals, Bettesworth said, already have or will soon install the necessary technological systems to participate in the program.

"What we will be doing is basically contracting with these hospitals for pharmacy oversight," Bettesworth said. "The rural hospitals are willing to purchase that type of service."

Although Bettesworth's staff is just beginning to quantify the benefits of the telepharmacy program, he predicts a major improvement in patient care.

"There's a lot of potential benefit—for not only reviewing orders and pharmacy oversight...but also just providing the basic foundation for pharmacy services in these small rural communities that don't have pharmacists," he said.