ASHP Midyear: Overcoming Staffing Challenges and Ensuring Medication Access in Rural Pharmacies

Brittany Norton, PharmD, director of ambulatory pharmacy at Sutter Health, discusses the challenges faced by rural pharmacies and hospitals in ensuring reliable medication access and staffing. Many rural facilities utilize remote order verification services, either internally or through outsourced providers, to address overnight and staffing shortages. However, the availability of drugs and supplies can be significantly delayed in rural areas compared to urban centers, requiring careful inventory management to avoid critical shortages of life-saving medications. Retaining pharmacists in rural settings is also a major challenge as there are often no backup options when staff need time off or vacations.

Pharmacy Times: How can telepharmacy and remote practice models help address workforce shortages in rural areas?

Brittany Norton: A lot of hospitals in rural areas and even retail pharmacies use various services for remote verification of orders. There's even some less rural places that use it overnight, if it's a smaller hospital because the staffing is difficult for overnight, and then in rural areas, they may not have a pharmacist readily available, so they're forced to use those services, but they're really nice. There's a lot of different places that offer them some offer it internal, if it's part of a larger health system, and the rural sister sites will have that, and then other places will outsource to other companies that do that as well, like Cardinal Health, who has a pretty large business model on remote order verification.

Pharmacy Times: What are the specific challenges related to limited resources, such as staffing, technology, and drug supply, in rural pharmacies?

Brittany Norton: So there's quite a few. One of the things with the drugs and supplies is, if you're in a major urban area, you may be able to order something and get at the very next day. However, in rural areas, you may need to wait a week or more, depending on how rural it is, so you really have to make sure you stay on top of your supplies so that you don't run out of life saving medications for patients. Staffing can be difficult. One thing I've seen is that you may be have a finally found a great pharmacist for a rural area and they want to use their PTO, but there's no one to cover them, and so that's a really difficult challenge. Is when you do finally find someone, they still need to have time off or go on vacation, so making sure you're supporting them by offering them coverage of vacation is a big challenge. A lot of rural areas will end up using staffing agencies for that, but I think that's definitely one area for people to look into more.

Pharmacy Times: Is there anything else you would like to add?

Brittany Norton: So in some rural areas, patients come from very far away. For example, where I work, there's patients that come from over 3 hours away. So if there's any delays in the medications getting delivered, that patient may have just a lot of times, they'll get hotel reservations and everything. So it really patients travel from very far in these rural areas because oftentimes if a rural area does have a pharmacy or a hospital, there's even smaller rural communities that use that as their hub, and so you really have to be mindful of that when planning for your staffing, your drug ordering, and things like that.