Undoubtedly, technology has rewritten the book in rural pharmacy. From automated dispensing machines to Skype meetings, technology has given rural pharmacy services a new lease on life.
At large urban hospital pharmacy sites in Alberta, staffing can be from 50 to more than 100 pharmacy assistants, technicians and pharmacists. While many of the province’s hospital pharmacy personnel work within these conditions, there is a group of pharmacy workers who are working in an entirely different setting. These are the pharmacy members who live and work in a rural location.
Alberta Health Services (AHS), the country’s largest province-wide integrated health system brings health services to the more than four million residents in the province. Since 1901, the rural population has steadily decreased; however, AHS indicates that 22% of Alberta’s population still lives in rural areas.[i] Much of rural Alberta has strong communities, and residents need access to professional and complete healthcare that doesn’t require moving to an urban center. Frankly, commuting to a city simply isn’t possible for most people in these remote locations. For example, Fort Vermilion is nearly 400 km north of Peace River and 660 km northwest of Edmonton.
The rural work place is considerably different than those in urban centers. While larger centers are able to draw from a larger pool of qualified pharmacy personnel, that is not the case with rural sites, particularly in small centers. Sites closer to larger centers often lose staff frequently to urban facilities.
Consider a work site where you are either the ONLY pharmacy staff member onsite or a member of a team of two or three people. Whether a pharmacy technician, or a pharmacist, to other healthcare members at the site, you are the PHARMACY. You are the person the nursing manager comes to on a Friday afternoon with a request for an obscure drug you don’t stock. You are the go-to for medication reconciliation of a newly admitted patient. Stocking ward stock shelves, ordering drugs, entering orders, medication reconciliations, filling daily batches: all of these can comprise your regular work day. While some may be tempted to think these staff members have an easy time of it, the reality can be quite different.
In northern Alberta, there are sites with as little as a single part-time pharmacy assistant (working three to four hours per day most week days), and many with no more than one full time pharmacy technician. Some have a part time pharmacist onsite, while others have only remote pharmacist and pharmacy technician coverage. While some areas of northern Alberta have fewer issues with staffing, one of the ongoing issues in rural locations is attracting and retaining staff.
There are other challenges as well – there is the physical distance between sites. In northern Alberta, most rural sites are more than 50 km from the next healthcare center and 100 km or more from a large center such as Edmonton or Grande Prairie. Accessing an urgently needed drug is not as simple as a quick call to the local wholesaler for delivery same day, and often, it is not possible to have product sent from another nearby facility in a timely manner. Some healthcare zones have regularly scheduled couriers between some sites…but that only helps IF a close site has the drug that is required. In northwestern Alberta, a new drug order in La Crete can mean a $150 taxi bill for the 115 km trip from High Level. The distance from major centers also can be an issue for drug deliveries even from wholesalers, especially during the winter months when a normal one-day turn around stretches to two…or longer if a weekend and inclement weather are involved.
As a result of these challenges, rural hospital pharmacies have benefitted greatly from advances in technology. Published in November 2018 the Canadian Society of Hospital Pharmacists (CSHP) developed guidelines for telepharmacy. The term has been listed as “the use of telecommunications technology to facilitate or enable the delivery of high quality pharmacy services in situations where the patient or healthcare team does not have direct (in-person) contact with pharmacy staff.”[ii] In rural Alberta, telepharmacy services are often provided in an intrasystem model, in which pharmacy resources are shared across multiple sites.
In 2009, Alberta Health Services explored its communication platforms to facilitate communication and collaboration across the province.[iii] Provincially Microsoft Lync (and its newest replacement, Skype) was brought in to every hospital site. This system allows users to send instant messages (IM), make phone calls and start or join online conferences and meetings with other users.[iv] Within pharmacy, region-wide online meetings are held regularly, building a sense of teamwork and networking peers together. Without leaving the pharmacy, staff members can participate in a real-time meeting. Region-wide updates and problem-solving sessions result in a more cohesive care model throughout the area.
Along with Lync and Skype in 2011 Alberta Health Services also installed document cameras within every facility. This technology allows a remote pharmacist or pharmacy technician to view medications and provide real-time final checks. With the aid of real-time cameras and Skype calls, a pharmacy technician can provide final checks for interim doses, ward stock, cart fills, and any other medication-related check. And this can happen for hundreds of kilometers away.
Telehealth is another technology used within Alberta Health Services. At some sites a dedicated room is set aside for video teleconferencing. This is often used for long distance meetings between doctors and patients, but is also used for many provincial meetings for staff, including pharmacy. It provides a video conference without the use of headphones or computers.
Emails and faxes still have their place within pharmacies as well. Faxes to retail pharmacies and doctors’ offices enable continuity of care for discharged patients.
Communication is not the only area in which technology is being utilized. In one region, centralized pharmacy production has moved most of the oral solids stock (tablets and capsules) to one site, allowing small sites to carry a fraction of inventory they would have had to stock otherwise. Weekly orders are placed to the central production site for medications, and sites with established courier routes can have daily medication deliveries sent directly to the care units.
Centralized drug ordering allows one team to process and follow up on drug orders, manage shortages or backorders, and move stock within the region when needed urgently.
All of these pieces allow the site staff to focus on patient care. Technology is changing the landscape of that as well. Technology is quickly becoming the backbone of rural healthcare. With the technological advances that have been made rural patients have good access to proper healthcare including pharmacy services.
It’s only going to get better. With work underway for a provincial information program within AHS, the information age will transform rural pharmacy again. A clinical information system (CIS) is being created to streamline patient information province-wide. The Alberta Health Services website says “Through a common provincial clinical information system, Connect Care will enable consistent practices across Alberta and will improve the care we provide for patients and their families”.[v] Still in the design stage, roll out is expected before 2025 across the province.
[ii] Telepharmacy: Guidelines (November 2018) p9. Retrieved February 7, 2019 from http://finprdweb.albertahealthservices.ca:10115/OA_CGI/FNDWRR.exe?temp_id=811212993
[v] Alberta Health Services website—Connect Care. Retrieved February 15, 2018 from https://www.albertahealthservices.ca/info/cis.aspx
Linda Eckel is a medication quality and safety pharmacy technician with AHS. She previously worked in the NorthEast zone. Linda one day aspires to be published in Tech Talk, becoming amazingly famous and outrageously wealthy. Until then she is committed to sharing as much information as her peers will allow.