Remote Pharmacy Services Offer Quality Assurance

by Candi Helseth

Pharmacist Dwayne Ragan

Pharmacist Dwayne Ragan provides remote pharmacy services from his home in Clyo, Georgia, to three critical access hospitals and one PPS (Prospective Payment System) hospital in Georgia.

When Ann Fagan Cook took over as administrator of Parkview Hospital in Wheeler, Texas, seven years ago, patient medication errors at the 16-bed critical access hospital (CAH) averaged about 4 percent.

Nurses at the CAH dispensed medications to patients, and a traveling pharmacist was on-site only eight hours a week.

“I’m a nurse by training and I found the medication errors very distressing,” Cook said. “When we had two near-misses where we came very close to using serious medications in the wrong amount, it was obvious we needed to do something different. But we also needed to find something we could afford.”

Parkview is among the 63 percent of CAHs nationwide that do not have full-time pharmacists on-site. Paul Moore, an Oklahoma pharmacist whose primary platform as the 2008 president of the National Rural Health Association was pharmacy issues, says, “About one-half of CAHs use a retail pharmacist either in their community or a neighboring community. As the number of independent pharmacies continues to decline throughout rural America, it’s one more example of how losing these small town services negatively impacts the community as a whole. Retail pharmacists often fill needs for the local hospital, EMS and other rural health care networks.”

Seeing the need for finding new ways to bring pharmacy services to rural providers, Moore created Remote Pharmacist Services (RPS), a private business, three years ago. Moore and other pharmacists review pharmacy inventories, check all orders, and provide therapeutic interventions before a medication is dispensed to patients in the hospitals RPS serves in Oklahoma, Georgia and Texas.

Within a few short months of implementing RPS’s services, Parkview’s error rate was down to less than one-half of 1 percent. “We’ve had the system in place about four years now and it has really made a great deal of difference in the quality of care we give to patients,” Cook said. “We have a lot of oil field injuries and vehicle accidents. We couldn’t afford to be making mistakes because when we transfer patients, they have to go a long ways from here.”

Susan Huckert

Susan Huckert, a pharmacy technician at Parkview Hospital in Wheeler, Texas, uses a bar coder to identify Katie Gallardo. If the bar code doesn’t match the patient’s identify, the card holding the patient’s medications will not open.

At a time when small facilities are already grappling with workforce issues related to the lack of pharmacists on staff or in the community, Moore said that several health care quality oversight groups, including the Joint Commission on Accreditation of Hospital Organizations (JCAHO), are demanding greater oversight of the medication distribution process by pharmacists to reduce medication errors.

“It’s pretty obvious that these rural providers aren’t going to be able to find full-time pharmacists even if they can afford them,” Moore said. ”With remote pharmacy, where you can leverage a pharmacist taking care of three to five hospitals, it becomes cost effective for these small hospitals. I hope it’s an idea that takes off in more states because it offers answers for small areas where the retail pharmacist is no longer available as a back-up.”

To learn more about RPS, contact Moore at

For more information on rural pharmacy and prescription drug issues in rural areas, see the following Rural Health Information Hub resources:

RHIhub Topic Guides

  • Pharmacy and Prescription Drugs Topic Guide
    Information, resources and frequently asked questions related to providing pharmacy services and access to prescription medications in rural communities.
  • Health Care Workforce Topic Guide
    Information and frequently asked questions on physicians, midlevel practitioners, pharmacy and dental health care providers for rural communities.

Publications indexed on the RHIhub website on:

Back to: Fall 2009 Issue