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Tyler Healthcare Center Pharmacy: Part 1

April Hanson, PharmD
Director of Pharmacy
Tyler Healthcare Center
Tyler, MN

Tyler Healthcare Center (THC) located in rural Tyler, MN (population 1200), approximately 80 miles northeast of Sioux Falls, SD, includes a 20 bed Critical Access Hospital, 2 medical clinics with 2 physicians and a physician’s assistant, a 40 bed nursing home, home health/hospice services and wellness and rehab programs.

Prior to July 1, 2004 pharmacy services at Tyler Healthcare Center were managed by the local retail pharmacist. On top of running the town’s only retail pharmacy, he staffed the hospital pharmacy an average of 1-2 hours a day. Another pharmacist from a nearby hospital also staffed the hospital’s pharmacy up to 8 hours a week. The duties of these pharmacists were limited to the dispensing of medications and reviewing orders for inpatients and outpatients. Because of the limited onsite pharmacist time, dispensing to inpatients involved placing pharmacy stock bottles and some use of unit-dosed medications in the medication cart. Nurses accessed the pharmacy and removed the medication they needed when a pharmacist was not available. During this time, onsite pharmacists were unavailable to answer healthcare provider questions and to collaborate with the medical and facility staff. The hospital also had an open formulary allowing for a large inventory compared to other rural hospitals of similar size. In the clinic, anticoagulation monitoring was performed by the patient’s primary care physician.

A residency position at the facility offered me the chance to develop pharmacy services at a site located in a rural community. I was attracted to the facility having a hospital, nursing home, home healthcare program and clinic under one roof, thus allowing me to work with various departments and to implement pharmaceutical care in both outpatient and inpatient settings. Another appealing feature of the site was the administration and medical staff’s wiliness to have a full- time pharmacist. Also, the University of Minnesota (U of MN) had developed a similar site in Paynesville,MN, which allowed for networking between THC, Paynesville and the U of MN. I began my residency within the Tyler Healthcare Center in July 2004. The program was funded through a grant and directed by the University of Minnesota College of Pharmacy. As a pharmacist dedicated solely to the Tyler Healthcare Center, I offered the opportunity to provide new pharmacy services and redirect operations to a more safe and efficient standard. This challenge brought opportunity for innovation and required an entrepreneurial mindset to overcome some barriers of the practice setting and identify the resources required to pursue a new standard of pharmacy care for the health system.