PATIENT ACCESS TO PHARMACY SERVICES IN SMALL AND RURAL HOSPITALS

To advocate that critical-access hospitals (CAHs) and small and rural hospitals meet national medication management and patient safety standards, regardless of size or location; further, 

To provide resources and tools to assist pharmacists who provide services to CAHs and small and rural hospitals in meeting standards related to safe medication use; further, 

To promote allocation policies that address the unique challenges faced by CAHs and small and rural hospital pharmacies in procuring medications and supplies.

Rationale

State legislation has sometimes exempted small or rural hospitals from requirements applied to others. For example, Texas has exempted hospitals with fifty or fewer beds in remote locations from requiring prospective medication order review by a pharmacist. Pharmacist prospective order review is a well-supported safety practice that is required by the Centers for Medicare & Medicaid Services Conditions of Participation, Joint Commission accreditation standards for hospitals, and in state practice acts. ASHP policy supports pharmacist prospective order review as a minimum standard for pharmacies in hospitals and a consistent standard of care for all patients regardless of where that care is provided. Furthermore, ASHP encourages under-resourced facilities, including rural settings, to employ alternative strategies, such as expanded use of telehealth and pharmacy technicians, to meet the challenges they face. In addition, ASHP recognizes that one of the challenges faced by these hospital is industry allocation practices (e.g, allocations based on previous purchases) and restrictive distribution criteria (e.g., requiring specific facilities, equipment, or staff) that reduce access to medications and other resources in times of critical need. ASHP advocates that those allocation practices be made more flexible to meet patient needs, especially in times of crisis.