Rural Health

A novel system lets rural hospitals obtain a remote pharmacist's review of medication orders around-the-clock

Having pharmacists review clinicians' medication orders has been posed as a solution to prevent medication errors from occurring in hospitals. However, hospitals in rural areas often encounter difficulty in providing 24-hour pharmacist coverage. A novel solution to this problem is an after-hours remote pharmacy order entry system (ARPOE) that lets rural hospitals submit medication orders to a hub hospital that offers round-the-clock pharmacy staff. A demonstration project was implemented to determine if eight rural hospitals in northern Minnesota would benefit from using an ARPOE. Pharmacists at a hub hospital in Duluth reviewed all medication orders written once rural pharmacy staff were off duty.

On more than 700 occasions in the first 20 months, pharmacists at the hub hospital identified potential drug problems for patients in the rural hospitals. The researchers suggest this shows the ARPOE system provided safer care for the patients than if no pharmacist review had been available. Additionally, nursing staff at the rural hospitals who were surveyed indicated their satisfaction with the pharmacy services, including timeliness, availability, and helpfulness of the pharmacy staff.

The authors stress that several factors were critical in implementing the ARPOE system. Participating hospitals should craft policies and procedures for rural and hub staff to follow when writing, transmitting, entering, and acknowledging medication orders. These systems also require staff commitment to the process and trust among rural and hub hospital staff.

This study was funded by the Agency for Healthcare Research and Quality (HS14965).

See "Implementing after-hours pharmacy coverage for critical access hospitals in northeast Minnesota," by Timothy P. Stratton, Ph.D., B.C.P.S., F.A.P.H.A., Marcia M. Worley, Ph.D., Mark Schmidt, B.S., and Michael Dudzik, B.S.Pharm, M.H.A., in the September 15, 2008, American Journal of Health-System Pharmacy 65(18), pp. 1727-1734.

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