Implementing after-hours pharmacy coverage for critical access hospitals in northeast Minnesota.

Purpose: A project that used health information technology (IT) to provide after-hours pharmacy coverage to critical access hospitals in northeast Minnesota is described.

Summary: SISU Medical Systems was established to address the health care IT needs of the Wilderness Health Care Coalition hospitals. Administrators and nursing and pharmacy leaders at several Wilderness Coalition hospitals were interested in obtaining after-hours pharmacy services to optimize patient safety. Eight of the Wilderness Coalition critical access hospitals obtained the technology necessary to allow pharmacy staff at St. Luke's Hospital (the hub hospital) in Duluth, Minnesota, to electronically enter orders into the rural hospitals' patient electronic medical records. The system placed the orders into the patients' medication profiles on automated dispensing machines located at seven of the eight rural hospitals. The pharmacy computer system allowed for medication order processing, drug interaction checking, medication dispensing via automated dispensing cabinets at the rural hospital sites, and formulary and inventory management. Medications that were not available in a rural hospital's automated dispensing cabinet were obtained from the locked pharmacy by the nurse supervisor. Round-the-clock pharmacy coverage was almost achieved. Participating rural hospitals received 24-hour coverage from the hub hospital during weekends and holidays, but no after-hours (4 a.m.-7 a.m.) coverage was provided on weekdays. The staff at the rural hospitals determined from their experiences that new orders were less likely to be written during these hours.

Conclusion: Using Internet-based health IT, pharmacists from a metropolitan (hub) hospital with round-the-clock pharmacist coverage participated in the care of patients at a number of small, rural hospitals and helped ensure that those patients received safe and effective medication therapy. The coverage provided by pharmacists at the hub hospital improved nursing satisfaction with the overall quality of pharmacy services provided by both the hub hospital and the local onsite pharmacists.